Reinventing Healthcare: Overview of recent changes to England’s NHS

One of the most contentious pieces of legislation by the Coalition Government has been around reforming the NHS. In spite of the unprecedented six month rest period; during the passage of the Bill the Health & Social Act 2012 is now in place and from 1 April 2013 the new organisations become fully operational. The Act brings in a new range of organisations with new powers and responsibilities, and, in many cases a real desire to do things differently and better.
For the past two decades the driving principle behind all NHS changes, and they tend to come every 5 years or so, has been the separation of commissioning (the people who buy healthcare on behalf of the public) from the people who provide healthcare. These reforms continue that journey and take some big steps to further creating a market in healthcare which is supposed to ensure that services are top quality for patients and best value for the taxpayer. At the heart of this reform was the placement of Primary Care Trusts with Clinical Commissioning Groups, made up of local GPs and other clinicians who are supposed to take commission decisions closer to the patient.
Commissioners – they decide what healthcare is needed in their areas and purchase this from providers. Under the old system there were 6-7 organisations commissioning healthcare in London, under the new system there are many more than 70. They fall under four main headings: Clinical Commissioning Groups – they commission around two thirds of all healthcare which includes services in hospitals, A&E, mental health, district nurses, podiatry etc. NHS England (primary care teams) they specialise in commissioning the services received from the GP. NHS England (specialist team) covers the areas of healthcare with low number of patients but high costs for special communities of patients such as for example prisoners. Local Authorities now receive funding to provide public health services in their area, including clinical services, such as sexual health.
Providers – In the short term the Act does not provide for immediate changes in the familiar pattern of healthcare changes in the familiar pattern of healthcare providers. However, it does introduce the concept if Any Qualified Provider which envisages an increasing range of services being put out to competitive tender with bidders from the NHS, private and third sectors having the opportunity to win these contracts to provide your healthcare.
Please note that eventually every NHS organisation is required to become a Foundation Trust (FT) within a set timetable, giving them semi-independent status within the NHS.
Patient & Public Engagement – The new system aims to provide more and better opportunities for the public to become involved in planning health care. Every local authority in London has established an independent Healthwatch service to support public involvement. They have also established Health & Wellbeing Boards which are responsible for producing Joint Strategic Needs Assessments – important documents that are supposed to inform commissioning decisions by CCGs, NHSE and local authorities own public health spending.

For the best overview of the financial challenges facing the NHS see “NHS and social care funding: the outlook to 2012/22”
Healthwatch England for further general information on getting involved:
To view a longer presentation on the issues covered go to

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