Intended for healthcare professionals


The coalition government’s plans for the NHS in England

BMJ 2010; 341 doi: (Published 14 July 2010) Cite this as: BMJ 2010;341:c3790
  1. Chris Ham, chief executive
  1. 1Kings’ Fund, London W1G 0AN
  1. c.ham{at}

    Much more work is needed to ensure they can deliver improvements in care

    The coalition government’s plans for the future of health care in England herald fundamental changes to both the anatomy and physiology of the NHS.1 These changes take forward reforms set out by the Labour government led by Tony Blair in 2002 and developed further by Ara Darzi in 2008, but they are much more ambitious and risky.2 3

    The anatomy of the NHS will be affected by the setting up of an independent commissioning board, the abolition of strategic health authorities and primary care trusts, and a new role for local authorities in promoting public health. Its physiology will be altered by the use of markets instead of targets to drive improvements in performance.

    On the provider side of the market, NHS foundation trusts will have greater autonomy, and independent sector providers will be encouraged to compete for patients. On the commissioner side, groups of general practices will take responsibility for most of the NHS budget and use their clinical expertise to bring about improvements in care. The operation of the market will be overseen by a new economic regulator. Its role will be to promote competition, regulate the prices paid to providers, …

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