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Feature NHS Reforms

Into the abyss? How the health bill affects the NHS

BMJ 2012; 344 doi: (Published 01 February 2012) Cite this as: BMJ 2012;344:e767
  1. Rebecca Coombes, features editor
  1. 1 BMJ, London WC1H 9JR
  1. rcoombes{at}

The Health and Social Care Bill already seems a reality out in the heartlands of the NHS, so what effect will its passing have? Rebecca Coombes reports

One year since the Health and Social Care Bill was published and you could be forgiven for thinking the UK parliament and the English NHS are living in parallel universes. While MPs and Lords wrangle over the enormous 350 page bill, and lobbyists, including doctors, fight to improve on the initial offering, out in the health service radical reform is already well underway. Transition to clinician-led commissioning has progressed so fast that it’s as if the actual passing of the bill was a mere incidental detail. As one commentator told the BMJ, “we’ve taken a running jump into the abyss.” The NHS has already laid waste to huge amounts of management capacity, undermining its ability to cope as the previous years of public sector largesse begin to recede. So when the bill finally receives royal assent, what difference will it make to the health service?

Without it general practitioners can’t legally commission health services

The bill is vital if general practitioners are to get the legal right to commission health services. The bill transfers these statutory powers to the clinical commissioning groups (CCGs) and the NHS Commissioning Board. Although the bill is not yet law, there are already 257 pathfinder CCGs, covering 97% of the population in England. The vast majority have been cleared to take on shadow budgets from April in advance of becoming fully operational next year. So if the bill was scrapped now, there is a serious question mark about whether primary care trusts (PCTs) could revert back to their previous role of commissioning the bulk of health services. PCTs have already been wound down to just 50 clusters—and many of their skilled managers have jumped ship. The …

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