Intended for healthcare professionals


Tony Blair launches radical NHS plan for England

BMJ 2000; 321 doi: (Published 05 August 2000) Cite this as: BMJ 2000;321:317
  1. Linda Beecham
  1. BMJ

    Prime Minister Tony Blair has launched a reform programme for the NHS in England that he believes will once again make it “the healthcare system the world most envies.”

    The plan proposes changes to consultants' and GPs' contracts; promises more doctors and nurses; sets targets for waiting times for treatment; recommends a concordat between the NHS and the private sector; and aims to reduce inequalities.

    Tony Blair criticised consultants' and GPs' contracts, which he said were “outdated and inflexible.” The government has ruled out “buying out” consultants in private practice, which it estimated would cost at least £700m ($1050m). Instead, newly qualified consultants will be contracted to work exclusively for the NHS for “perhaps the first seven years” of their career, providing eight fixed sessions and more of the out of hours service.

    The right to undertake private practice will depend on fulfilling job plans and NHS service requirements. If agreement cannot be reached on these changes the government says that it will consider introducing a new specialist grade for newly qualified hospital specialists. In addition, all existing consultants will have to work seven fixed sessions a week.

    Distinction awards and discretionary points, which provide £170m a year in superannuable bonus payments for senior doctors, will be merged into a single, more graduated scheme with increased funding. This will enable more awards to be made and ensure that most new awards go to consultants who are making the biggest contribution to the NHS.

    GPs will be encouraged to move on to personal medical contracts, which will reward them on the basis of quality of care as well as numbers of patients. The government expects to see an increase in the number of salaried GPs. The prime minister said, “This will be the most significant change to the way GPs operate since 1948 and can literally transform primary care in this country.”

    More doctors, more nurses

    In March the government announced a real terms increase in spending on the NHS of over 6.3% The plan shows that over the next five years the extra money should provide 7500 more consultants, a rise of 30%; 1000 more specialist registrars; 2000 extra GPs and 450 more trainees; 1000 more medical training places each year, on top of the 1000 already announced; more than 20000 extra qualified nurses; and 6500 more therapists and other health professionals.

    There will be 7000 more beds in hospitals and intermediate care and 100 new hospital schemes in the next 10 years. The government plans to modernise 3000 GP premises by 2004 and open 500 new one-stop primary care centres.

    By 2005 the maximum waiting time for outpatients will be three months and for inpatients six months. No one should be waiting more than four hours in accident and emergency departments by 2004.

    By the end of 2005, waiting lists for hospital appointments and admissions will be abolished and replaced with booking systems designed to give patients a choice of a convenient time within a guaranteed maximum waiting time.

    By the end of this year NHS Direct, the 24 hour telephone helpline, will cover the whole of England, and by 2004 a single phone call to NHS Direct will be a one-stop gateway to out of hours care, with calls being passed on, where necessary, to the appropriate GP cooperative or deputising service. Also by 2004 all patients should be able to see a GP within 48 hours.

    By 2004 most NHS staff will be working under agreed protocols identifying how common conditions should be handled and which staff can best handle them. The government believes this will help to remove the demarcations that have held back staff and slowed down care.

    Bigger role for nurses

    By 2001 around 23000 nurses will be able to prescribe a limited range of medicines, and by 2004 a majority of nurses should be able to prescribe, working to protocols authorised by a doctor and a pharmacist.

    The public consultation called for a “modern matron figure” in hospitals, and ward sisters or charge nurses will be given authority to resolve clinical issues. By April 2002 every hospital will have senior sisters and charge nurses who are easily identifiable to patients and will be accountable for a group of wards. By 2004 there will be around 1000 nurse consultants in the NHS.

    The NHS Plan: A Plan for Investment, a Plan for Reform is available from the Stationery Office, price £15, and is at

    Full story in News Extra at

    Key points of the NHS Plan

    • Consultants to commit their first seven years to the NHS

    • 7000 more beds and 100 new hospital schemes by 2010

    • All patients to see a GP within 48 hours by 2004

    • Booking systems to replace waiting lists

    • A patient advocacy service for each trust

    • A UK council to coordinate the profession's regulatory bodies

    Embedded Image

    Tony Blair outlines the plan in the Commons

    (Credit: PA)

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