Private companies are to provide GP services in run-down areas in an attempt to close the "health gap" between the middle and working classes.
In a White Paper to be published today, the Government will admit that the well off get a better deal from the National Health Service than the poor because they are better at playing the system and demanding treatment.
Patricia Hewitt, the Secretary of State for Health, will pledge to end rules that in effect allow affluent areas, which often overspend their budgets, to be subsidised by poor areas, which often underspend. Examples include a transfer between London's East End and West End, and between Easington, Durham and affluent parts of Yorkshire.
Ms Hewitt will allow commercial operators to set up surgeries in areas with a shortage of doctors. She hopes to allay fears among Labour MPs about "back door NHS privatisation" by saying that the reform will ensure greater fairness and social justice.
In the foreword to the White Paper, Tony Blair will say his Government has failed to make fast enough progress in ensuring greater equality of treatment on the NHS. He will say: "It is still the case that where you live has a huge impact on your well-being and the care you receive. These health inequalities remain much too stark - across social class and income groups, between different parts of the country and within communities.
"The new emphasis on prevention will help close the health gap.
"So will encouraging GPs and other providers to expand services in the poorer communities."
The Prime Minister will argue that the White Paper on services outside hospitals would meet the public's preference to have as much treatment as possible at or near home. With the big rises in NHS spending due to end in 2008, he said that the "sustained shift" would also ensure more efficient use of resources.
The proposals include ensuring that consultants carry out minor surgery in clinics rather than in hospitals; longer opening hours for GPs' surgeries; allowing shops such as Tesco and Boots to open doctors' surgeries and an expanded role for practice nurses and pharmacists. Some 5 per cent of activity carried out in hospitals, costing £2.5bn a year, could be shifted closer to people's homes.
Plans for health checks, called an MoT test, at five points during a person's life will be rolled out in the poorest areas first as part of the drive to end health inequalities. A social enterprise unit will be set up in the Department of Health to encourage voluntary groups and doctors' and nurses' co-operatives to run surgeries.
Although treatment would remain free, Labour MPs are worried about surgeries being run by private firms, some of which could be foreign-based. But their scope for rebellion will be limited because the change will not require new legislation. Ministers have abandoned plans for 100,000 primary care trust staff to transfer to new private and voluntary suppliers after a backlash from Labour backbenchers.
Ms Hewitt told Sky News yesterday: "It's always been a problem with the NHS that the poorest areas tend to have the poorest services. The truth is there are fewer GPs per head in the areas that need them most.
"What we need is the local NHS having the freedom to go and say, we have not got enough GPs here, and try to get them in. I am not sure we are going to need to put more money in, but we need new providers."
Mr Blair will say: "We want change to be driven, not centrally, but in each community by the people who use services and by the professionals who provide them. By giving frontline professionals and the public more say and control over the services they provide and receive, I am confident that we will continue building a high-quality health and social care system which meets the future needs and wishes of the country."Reuse content