Patients promised more choice in NHS shake-up

GP practices will be obliged to join forces to commission treatment directly under a reform blueprint published by Health Secretary Andrew Lansley.

They will be handed much of the multimillion-pound budget currently handled by primary care trusts (PCTs), which will be abolished along with strategic health authorities.

An independent NHS Commissioning Board will oversee the new regime, with local councils taking over the public health element of PCTs' work.

Under plans set out in a White Paper, the Government also promised to scrap "top-down" targets in favour of a regime based on clinical outcomes.

And patients will be handed more choice over how and where they are treated.

The document warned that NHS job losses were "inevitable" but said it was vital to switch cash from bureaucracy into frontline services.

Mr Lansley said: "The sick must not pay for the debt crisis left by the previous administration. But the NHS is a priority for reform too.

"Investment has not been matched by reform. So we will reform the NHS to use those resources more effectively for the benefit of patients."

Mr Lansley said the new structure would "put patients right at the heart of decisions made about their care (and) put clinicians in the driving seat on decisions about services".

Under the new model, consortia of GPs in England will be directly responsible for commissioning the "great majority" of NHS services for their patients.

Specialist commissioning will be carried out by the new board, which will also distribute funds to the consortia, which the Government wants to have in place by next year.

Mr Lansley said that all NHS trusts will become Foundation Trusts, giving more freedom from Whitehall control.

And he said he wanted to open up the NHS to "any willing provider" able to meet standards in what he said would be the "largest social enterprise sector in the world".

The Government is seeking to slash NHS management costs by 45% over four years, and the White Paper acknowledged that would mean job losses.

"Inevitably, as a result of the record debt, the NHS will employ fewer staff at the end of this Parliament," it said, suggesting staff would be more concentrated on the front line.

"This is a hard truth which any government would have to recognise," it said.

Mr Lansley told MPs the scale of the reforms was "challenging" but denied breaking a pre-election promise to spare the health service from further top-down reorganisations.

He said he was simply accelerating and building on work that was already going on

"As we empower the front line, so we must disempower the bureaucracy. So after a transitional period, we will phase out the top-down management hierarchy, including both strategic health authorities and primary care trusts."

But shadow health secretary Andy Burnham said 10 years of "painstaking work" to raise standards in the NHS had been "thrown in the air".

"It is a huge gamble with an NHS that is working well for patients," he said.