The NHS in England is to undergo a radical reorganisation, with GPs commissioning most services and the abolition of primary care trusts and strategic health authorities.

The government’s white paper contains far reaching proposals that devolve power from central government to patients and doctors. Reaction to the proposals has been mixed, with one concern being whether GPs will be given enough support to take on their new expanded role. Another worry is that such large scale change is risky at a time when huge efficiency savings have to be made.

A key plank of the white paper is that all general practices must join a consortium that will commission the majority of care for their patients. It is anticipated that GP consortiums will hold around 80% of the total NHS budget. The white paper states that the new model is “neither a recreation of GP fundholding nor a complete rejection of practice-based commissioning.”

There will be no fixed size for the commissioning consortiums, although the white paper says that they must be big enough to manage financial risk and allow for accurate allocations. The aim is for a shadow system of consortiums to be in place in 2011-12, with primary care trusts supporting practices during the transition process. GP consortiums will take on responsibility for commissioning in 2012-13 and will take full responsibility from April 2013. At this date all 152 primary care trusts will be abolished.

An independent and accountable NHS Commissioning Board will be established, which will hold the consortiums to account for their performance and quality. It will also allocate NHS resources to the consortiums, set commissioning guidelines, and commission dentistry, community pharmacy, primary ophthalmic, and maternity services. This will pave the way for the abolition of the 10 strategic health authorities in 2012-13.

Launching the white …