Planet Insurance: NHS changes

Last month, I reported briefly on the abandoning of targets in the NHS following revision of the Department of Health's Operating Framework.

It turns out that this was just a taste of what was to come with the NHS White Paper - probably the most radical and far reaching set of reforms since Ken Clarke's days at the Department.

I think there are essentially three key areas.

First, (and no one will admit it) centralisation. At an England level there will be an NHS Commissioning Board which will draw up an NHS Outcomes Framework. This will move away from the current process targets (eg waiting times) and move to outcome based ones (like mortality and morbidity).

In practice, its standards will be set by NICE's new quality standards. There are 3 at the moment but 150 are predicted to be developed in the next five years and each one will have 5-10 measures in it.

NICE will also develop standards for social care - which will not go down well with non-clinicians. In addition there will be a new public health service (another White Paper to follow in the Autumn); an enhanced role for Monitor which will regulate competition law compliance by all health and social care providers, including in the private sector and will set maximum prices in the public sector; a new "Health Watch England" to provide advice to the other bodies on patient experience; a new Health and Social Care Information Centre to help patients make informed choices; and finally (in the transition period) an enhanced role for DH and existing Regional and local NHS commissioning bodies in ensuring financial control.

Second, devolution and reconfiguration. All GP practices will have to team up into "GP Consortia" and take over the commissioning functions from Primary Care Trusts and Strategic Health Authorities. These will be abolished.

It will be interesting to see how GPs react to this. Previous models (GP fund-holding and practice based commissioning) were voluntary. And GP wide change has previously only been imposed with the sweetener of a wad of cash (as happened with the GP contract).

That said, they will be able to outsource the boring bits (demographic analysis, contract negotiation, performance monitoring, financial management) -.an opportunity for the private sector to take these functions on.

In addition, Local Authorities have been given new responsibilities for public health and will have to set up "health and wellbeing boards" as well as taking on funding for local "Health Watch" organisations (the successors to CHCs, PALs, and LINks - 4 reorganisations since 1997). NHS Foundation Trust status will also be compulsory - realising the previous Government's intentions under Tony Blair.

Third, continuing on the Blair theme, choice. Choice of service provider will finally be fully implemented. In addition there will be a choice of consultant- led team, and more choice on maternity, mental health, diagnostics, long term care, and end-of-life services. Most tellingly, patients will finally have a choice of GP, not restricted to where they live, which will be popular with commuters but a challenge for private medical centres.

I have saved my favourite bit until the end. Patients will finally own their own health data and I quote paragraph 2.12 "We will make it simple for a patient to download their record and pass it, in a standard format, to any organisation of their choice". Finally, an end to GP reports for insurance?

Richard Walsh is a director and fellow of SAMI Consulting.