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U.K. Government Details Key Changes to Health Reform Plan

The U.K. government recently outlined proposed modifications to the Health and Social Care Bill that Health Secretary Andrew Lansley submitted to Parliament earlier this year. Key changes include:

  • GP consortia will become "clinical commissioning groups," which include wider involvement and input from other health professionals. These clinical commissioning groups will be required to include a hospital specialist and a nurse on their boards, which will now also be obligated to meet in public and publish their minutes. They are also expected to be established in geographical regions and will be responsible for commissioning all emergency care within their boundaries. To prevent "cherry picking," the commissioning groups will also be explicitly responsible for unregistered patients who reside in their area.
  • The government has proposed a new implementation timeline. Primary Care Trusts will still be abolished, and all general practices will still be required to join a clinical commissioning group (formerly GP consortium) by April 2013. However, only those "ready and willing" to take up commissioning responsibilities will be authorized to do so. Those not ready to take on full responsibility have the option to form a "shadow" group, and the National Health Service (NHS) Commissioning Board will commission on its behalf. There remains no option for GP practices to opt out of commissioning entirely. The revised timeline also removes the requirement that all NHS trusts become foundation trusts by April 2014.
  • Competition in the NHS will be based explicitly on quality, not price. Further, commissioners will be required to purchase services based on the best value, rather than the lowest prices. Monitor, the NHS regulator, will now focus on protecting patients from abuses, and will no longer be tasked with promoting competition (as an end in itself). It will now also be responsible for promoting and supporting integration of services when integration would improve quality for patients or improve efficiency.
  • Education and training were not included in the original bill and will now be incorporated to ensure that education and training programs are overseen during the transition period while the reforms are being implemented, and that education and training align with the new health system. Considerations include leadership and accountability for the education and training system, as well as ensuring protected funding.

For the most part, these changes accept the recommendations of the NHS Future Forum, the independent body established in April at the beginning of the eight-week "listening exercise," which is responsible for exposing public concerns and criticisms to the government's health reform plans. In particular, the NHS Future Forum, a group of 40 experts chaired by Professor Steve Field, immediate past chairman of the Royal College of General Practitioners, aimed to respond to concerns over the pacing and implementation of the reforms. Some of the changes will require reexamination under the committee stage in the House of Commons, which had already passed the bill.


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