Intended for healthcare professionals

Feature Briefing

Health and Social Care Bill

BMJ 2011; 342 doi: (Published 26 January 2011) Cite this as: BMJ 2011;342:d507
  1. Rebecca Coombes, features editor, BMJ
  1. rcoombes{at}

The Health and Social Care Bill—all 281 clauses of it—was introduced into Parliament last week. The draft legislation for England is largely the vision of health secretary Andrew Lansley. Health unions fear that the reforms, which hand general practitioners control of over 80% of the NHS budget, are a cloak for privatisation.

Pace of reform

Lansley’s insistence on a breakneck speed for his reforms could be his downfall, say critics. By April 2013, the 152 primary care trusts will be abolished and all general practitioners required to join a commissioning consortium. The pace is breathtaking. One scenario is that this wholesale transition won’t be possible. Nuffield Trust director Jennifer Dixon believes that “in areas where there are the weakest consortia, PCTs will remain in existence for much longer than 2013.”

Cost of reform

The upfront cost of putting reforms in place—to be largely incurred between this year and 2013—is estimated to be £1.4bn (€1.6bn, $2.2bn). This includes redundancy costs of £1bn. The remainder of the cost will be run up by transferring IT systems and staff from PCT to consortium premises, and start-up costs for consortiums. The Department of Health expects 50-70% of staff will transfer from PCTs/strategic health authorities to new structures, including consortiums.

Lansley is hoping for a reduction of a third in administration spending. By 2014-5, the NHS in England (excluding the acute sector) is expected to be spending £1.7bn less …

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