Dobson gives GPs power over NHS

A SEISMIC SHIFT in the NHS will switch control of the vast bulk of its pounds 40bn budget from hospitals and health authorities to family doctors and nurses. The Health Bill revealed yesterday is to transform general practice into the driving force behind the NHS.

From April, 481 Primary Care Groups covering England will be established, replacing the discredited GP fundholding system, which covers half the population, with the eventual aim of giving the groups responsibility for all the care provided to their patients.

The Bill also establishes new mechanisms to prevent a repeat of the Bristol heart babies disaster by instituting checks on quality in every hospital, known as "clinical governance", and a hit squad called the Commission for Health Improvement to solve problems.

Other measures include the creation of joint budgets between the NHS and social services, tough new rules to prevent drug company profiteering, and changes to the professional self-regulation of doctors.

At the heart of the Bill lie the plans for general practice. Initially, the Primary Care Groups, made up of about 50 GPs each, will advise health authorities on allocation of funds to hospitals and community services, moving by stages to take over their commissioning functions.

From April 2000, the first Primary Care Trusts will be set up, running community hospitals and district nursing services and offering a low-tech alternative to the hi-tech care of large hospitals. Patients will not notice the change at first, but the moves will accelerate the trend to more care in GP surgeries and health centres. By giving family doctors and their professional colleagues control of the health budget, the range of services provided in surgeries and health centres will expand. Hospitals will become increasingly specialised and there will be fewer of them.

The question is whether family doctors and their colleagues have the will or the expertise to manage the vast sums involved.

Dr Jonathan Levy, a GP fundholder in Mill Hill, north London, said: "It is going to be awful. I am a doctor and I want to get on with treating patients. To get what you want you have to be on the committee but my main aim will be to ensure it doesn't take up too much time."

Frank Dobson, the Secretary of State for Health, said yesterday that the new freedoms for Primary Care Trusts would lead to the development of walk-in health centres on the high street, providing day surgery, health screening, physiotherapy and advice clinics. Money from the NHS modernisation fund will pay for complete computerisation of doctors' surgeries.

He said: "The changes we are making will take time. But [they] will totally transform how the health service cares for patients. They will deliver a system moulded to the needs of the patient, rather than the current arrangements, which sometimes appear to be organised the other way around."

Department of Health officials said the aim of the Bill was to make the NHS faster and more convenient for patients, to guarantee standards across the country, and to ensure that healthcare and social services worked together to meet the needs of patients.