Jeremy Laurance, Health Editor, examines Labour's attempt to mould the Tory legacy of the health service in its own image.
Every patient with suspected cancer will be seen by a specialist within two weeks of referral by their family doctor, Frank Dobson, the Secretary of State for Health pledged yesterday. The guarantee will apply to cases of suspected breast cancer by April 1999 and to all other cancers by 2000 and will cut waiting times which for some patients have run to months.
However, the move was immediately criticised by one senior surgeon who said it would mean cancer patients whose condition was either not urgent or untreatable might be put ahead of others with life threatening conditions who could be saved.
The cancer pledge was being presented as the first example of a new clinical standard to lever up quality in a health service that has become pre-occupied with quantity in a market driven by competition.
Mr Dobson said the White Paper - "The New NHS" - marked a turning point which would give the NHS, 50 years old next year, a new lease of life.
The internal market is to be abolished, GP fundholding will be scrapped and competition is to be outlawed. In their place, teams of GPs and community nurses, to be known as Primary Care Groups, will take control of the vast bulk of the NHS's resources and, under the watchful eye of health authorities which will have a new monitoring role, negotiate long-term three-year agreements with NHS trusts over the best provision of services for their areas.
The most radical aspect of the proposals was being seen last night as the plan to create Primary Care Trusts which would effectively control all aspects of the health care of their local populations. Primary Care Groups will be able to take over the running of local community hospitals and apply for trust status, bridging the divide between hospital and community care.
Health policy experts compared the new trusts to American Health Maintenance Organisations which provide all necessary care to their members within a fixed budget. The new Primary Care Trusts will provide all the normal GP services, including district nurses and health visitors, plus hospital care for conditions that do not require the full panoply of skills and equipment available in a large district general hospital. As the trusts will control the entire budget for the care of their local populations, they will have an incentive to provide care at the local level rather than referring patients to the expensive NHS trust.
Professor Chris Ham, director of the Health Management Centre at the University of Birmingham said: "It is more radical than many people supposed. The Government is not just carrying the NHS market forward by another name. The radicalism is in the Primary Care Trusts which are being seen as the founding stone of the new NHS."
Gordon Best, director of management consultants OD partnerships and a fellow of the Kings Fund, the health policy think tank, said the new trusts represented a major expansion of the gatekeeping role carried out by GPs. "When you put GPs and community trusts together, hospital doctors will join them. They will try to keep patients out of [the acute hospital's] beds."
Mr Dobson also announced plans to connect every GP surgery to the NHSnet - the NHS's version of an information superhighway - which will allow patients to get speedier results and specialist advice in the local surgery and make immediate bookings for out-patient appointments. The first demonstration sites are to be launched next year and the service is planned to be available across the country by 2002.
A new 24-hour telephone hot-line, called NHS Direct and to be staffed by nurses, will help to reduce pressure on hospitals and GPs by giving on-the-spot advice. Three pilot helplines are to begin next March.Reuse content