The Health and Social Care Act 2012
c 7 is an
act of the
Parliament of the United Kingdom
The Parliament of the United Kingdom is the supreme legislative body of the United Kingdom, the Crown Dependencies and the British Overseas Territories. It meets at the Palace of Westminster, London. It alone possesses legislative suprema ...
. It provided for the most extensive reorganisation of the structure of the
National Health Service in England
The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the ...
to date.
['']BMJ
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origina ...
'', 2011; 342:d408
Dr Lansley's Monster
It removed responsibility for the health of citizens from the
Secretary of State for Health
The secretary of state for health and social care, also referred to as the health secretary, is a secretary of state in the Government of the United Kingdom, responsible for the work of the Department of Health and Social Care. The incumbent ...
, which the post had carried since the inception of the NHS in 1948. It abolished
primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s (PCTs) and
strategic health authorities
Strategic health authorities (SHA) were part of the structure of the National Health Service (England), National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementin ...
(SHAs) and transferred between £60 billion and £80 billion of "commissioning", or healthcare funds, from the abolished PCTs to several hundred
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s, partly run by the
general practitioners (GPs) in England. A new
executive agency
An executive agency is a part of a government department that is treated as managerially and budgetarily separate, to carry out some part of the executive functions of the United Kingdom government, Scottish Government, Welsh Government or Nort ...
of the
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
,
Public Health England
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
, was established under the act on 1 April 2013.
The proposals are primarily the result of policies of the then Secretary of State for Health,
Andrew Lansley
Andrew David Lansley, Baron Lansley, (born 11 December 1956) is a British Conservative Party (UK), Conservative politician who previously served as Secretary of State for Health and Social Care, Secretary of State for Health and Leader of the H ...
. Writing in the ''
BMJ
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origina ...
'',
Clive Peedell (co-chairman of the
NHS Consultants Association and a consultant clinical oncologist) compared the policies with academic analyses of
privatisation
Privatization (also privatisation in British English) can mean several different things, most commonly referring to moving something from the public sector into the private sector. It is also sometimes used as a synonym for deregulation when ...
and found "evidence that privatisation is an inevitable consequence of many of the policies contained in the Health and Social Care Bill". Lansley said that claims that the government is attempting to privatise the NHS are "ludicrous scaremongering".
The proposals contained in the act were some of the coalition government's most controversial. Although mentioned in the Conservative Party's manifesto in 2010, they were not contained in the
Conservative–Liberal Democrat coalition agreement,
[ which mentioned the NHS only to commit the coalition to a real-term funding increase every year. Within two months of the election a ]white paper
A white paper is a report or guide that informs readers concisely about a complex issue and presents the issuing body's philosophy on the matter. It is meant to help readers understand an issue, solve a problem, or make a decision. A white paper ...
was published, outlining what ''The Daily Telegraph
''The Daily Telegraph'', known online and elsewhere as ''The Telegraph'', is a national British daily broadsheet newspaper published in London by Telegraph Media Group and distributed across the United Kingdom and internationally.
It was fo ...
'' called the "biggest revolution in the NHS since its foundation".['']Daily Telegraph
Daily or The Daily may refer to:
Journalism
* Daily newspaper, newspaper issued on five to seven day of most weeks
* ''The Daily'' (podcast), a podcast by ''The New York Times''
* ''The Daily'' (News Corporation), a defunct US-based iPad new ...
'', 9 July 2010
Biggest revolution in the NHS for 60 years
/ref> The bill was introduced in the House of Commons
The House of Commons is the name for the elected lower house of the bicameral parliaments of the United Kingdom and Canada. In both of these countries, the Commons holds much more legislative power than the nominally upper house of parliament. ...
on 19 January 2011.[http://www.parliament.uk]
Bill stages – Health and Social Care Bill 2010-11
/ref> In April 2011 the government announced a "listening exercise", halting the Bill's legislative progress until after the May local elections; the "listening exercise" finished by the end of that month. The Bill received Royal Assent
Royal assent is the method by which a monarch formally approves an act of the legislature, either directly or through an official acting on the monarch's behalf. In some jurisdictions, royal assent is equivalent to promulgation, while in other ...
on 27 March 2012.
Background
The proposals in the act were not discussed during the general election
A general election is a political voting election where generally all or most members of a given political body are chosen. These are usually held for a nation, state, or territory's primary legislative body, and are different from by-elections ( ...
campaign in 2010 and were not contained in the Conservative–Liberal Democrat coalition agreement of 20 May 2010,[ which declared an intention to "stop the top-down reorganisations of the NHS that have got in the way of patient care".][ However, within two months a white paper outlined what the '']Daily Telegraph
Daily or The Daily may refer to:
Journalism
* Daily newspaper, newspaper issued on five to seven day of most weeks
* ''The Daily'' (podcast), a podcast by ''The New York Times''
* ''The Daily'' (News Corporation), a defunct US-based iPad new ...
'' called the "biggest revolution in the NHS since its foundation".[ The white paper, ''Equity and Excellence: Liberating the NHS'',] was followed in December 2010 by an implementation plan in the form of ''Liberating the NHS: legislative framework and next steps''. McKinsey & Company
McKinsey & Company is a global management consulting firm founded in 1926 by University of Chicago professor James O. McKinsey, that offers professional services to corporations, governments, and other organizations. McKinsey is the oldest and ...
who have been influential in the British Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
for many years was heavily involved in the discussions around the Bill. The bill was introduced into the House of Commons
The House of Commons is the name for the elected lower house of the bicameral parliaments of the United Kingdom and Canada. In both of these countries, the Commons holds much more legislative power than the nominally upper house of parliament. ...
on 19 January 2011[ and received its second reading, a vote to approve the general principles of the Bill, by 321–235, a majority of 86, on 31 January 2011.
]
White Paper
The act had implications for the entire English NHS. Primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s (PCTs) and strategic health authorities
Strategic health authorities (SHA) were part of the structure of the National Health Service (England), National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementin ...
(SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff. £60 to £80 billion worth of commissioning will be transferred from PCTs to several hundred clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s, partly run by GPs. Around 3,600 facilities owned by PCTs and SHAs would transfer to NHS Property Services NHS Property Services is a limited company owned by the Department of Health in the United Kingdom that took over the ownership of around 3,600 National Health Service (NHS) facilities in April 2013.
Following the Health and Social Care Act 2012, s ...
, a limited company
In a limited company, the liability of members or subscribers of the company is limited to what they have invested or guaranteed to the company. Limited companies may be limited by Share (finance), shares or by guarantee. In a company limited by ...
owned by the Department of Health.
When the white paper was presented to Parliament, the Secretary of State for Health, Andrew Lansley, told MPs of three key principles:
*patients at the centre of the NHS
*changing the emphasis of measurement to clinical outcomes
*empowering health professionals, in particular GPs.
The white paper set out a timetable. By April 2012 it proposed to:
*establish the independent NHS Commissioning Board
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
*establish new local authority health and well-being boards
*develop Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
as an economic regulator.
The Bill foresaw all NHS trusts becoming, or being amalgamated into, foundation trust
A foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local s ...
s. The Bill also abolished the existing cap on trusts' income from non-NHS sources, which in most cases was previously set at a relatively low single-digit percentage.
Under the Bill's provisions the new commissioning system was expected to be in place by April 2013, at which time SHAs and PCTs would be abolished.
The Bill was analysed by Stephen Cragg of Doughty Street Chambers, on behalf of the 38 Degrees campaign, who concluded that "Effectively, the duty to provide a national health service would be lost if the Bill becomes law, and would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible." It replaces a "duty to provide" with a "duty to promote".
"Listening exercise"
After an increase in opposition pressure, including from both rank-and-file Liberal Democrats and the British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
, the government announced a "listening exercise" with critics. On 4 April 2011 the government announced a "pause" in the progress of the Bill to allow the government to 'listen, reflect and improve' the proposals.
The Prime Minister
A prime minister, premier or chief of cabinet is the head of the cabinet and the leader of the ministers in the executive branch of government, often in a parliamentary or semi-presidential system. Under those systems, a prime minister is not ...
, David Cameron
David William Donald Cameron (born 9 October 1966) is a British former politician who served as Prime Minister of the United Kingdom from 2010 to 2016 and Leader of the Conservative Party from 2005 to 2016. He previously served as Leader o ...
, said "the status quo is not an option" and many within his and Nick Clegg
Sir Nicholas William Peter Clegg (born 7 January 1967) is a British media executive and former Deputy Prime Minister of the United Kingdom who has been president for global affairs at Meta Platforms since 2022, having previously been vicepr ...
's coalition said that certain aspects of the Bill, such as the formation of Clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s, were not only not open for discussion, but also already too far along the path to completion to be stopped. Cameron insisted that the act was part of his " Big Society" agenda and that it would not alter the fundamental principles of the NHS.
Part of the "listening exercise" saw the creation on 6 April 2011 of the "NHS Future Forum". The Forum, according to ''Private Eye
''Private Eye'' is a British fortnightly satire, satirical and current affairs (news format), current affairs news magazine, founded in 1961. It is published in London and has been edited by Ian Hislop since 1986. The publication is widely r ...
'', "brings together 43 hand-picked individuals, many of whom are known as supporters of Lansley's approach".['']Private Eye
''Private Eye'' is a British fortnightly satire, satirical and current affairs (news format), current affairs news magazine, founded in 1961. It is published in London and has been edited by Ian Hislop since 1986. The publication is widely r ...
'', Issue 1288, "Is anybody listening?", p30 At the same time, David Cameron set up a separate panel to advise him on the reforms; members of this panel include Lord Crisp
Edmund Nigel Ramsay Crisp, Baron Crisp (born 14 January 1952) is a crossbench member of the House of Lords where he co chairs the All-Party Parliamentary Group on Global Health. He works and publishes extensively in global health and internationa ...
(NHS chief executive 2000–2006), Bill Moyes (a former head of Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
), and the head of global health systems at McKinsey
McKinsey & Company is a global management consulting firm founded in 1926 by University of Chicago professor James O. McKinsey, that offers professional services to corporations, governments, and other organizations. McKinsey is the oldest and ...
,[ as well as ]Mark Britnell
Mark Douglas Britnell (born 5 January 1966) is an English business executive. He is a senior partner at the professional services firm KPMG and a global healthcare expert. He was the chairman and senior partner for healthcare, government and infras ...
, the head of health policy at KPMG
KPMG International Limited (or simply KPMG) is a multinational professional services network, and one of the Big Four accounting organizations.
Headquartered in Amstelveen, Netherlands, although incorporated in London, England, KPMG is a net ...
. Six months previously Britnell had told a conference of private healthcare executives that "In future, the NHS will be a state insurance provider not a state deliverer," and emphasised the role of Lansley's reforms in making this possible: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years." KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating
In June 2011 Cameron announced that the original deadline of 2013 would no longer be part of the reforms. There would also be changes to the Bill to make clear that the main duty of the health regulator, Monitor, was to promote the interests of patients rather than promoting competition.
The Future Forum report suggested that any organisation that treats NHS patients, including independent hospitals, should be forced to hold meetings in public and publish minutes. It also wanted the establishment of a Citizens' Panel to report on how easy it is to choose services, while patients would be given a right to challenge poor treatment. The original Bill sought to abolish two tiers of management and hand power to new bodies led by GPs, called commissioning consortia, to buy £60 billion a year in treatment. Professor Steve Field, a GP who chaired the forum, said many of the fears the public and medical profession had about the Health and Social Care Bill had been "justified" as it contained "insufficient safeguards" against private companies exploiting the NHS.
Amendments
Following the completion of the listening exercise, the Bill was recommitted to a public bill committee on 21 June 2011. On 7 September, the Bill passed the House of Commons and received its third reading by 316–251. On 12 October 2011, the Bill was approved in principle at second reading in the House of Lords by 354–220. An amendment moved by Lord Owen
David Anthony Llewellyn Owen, Baron Owen, (born 2 July 1938) is a British politician and physician who served as Secretary of State for Foreign and Commonwealth Affairs as a Labour Party MP under James Callaghan from 1977 to 1979, and later ...
to commit the most controversial clauses of the Bill to a select committee was defeated by 330–262. The Bill was subsequently committed to a committee of the whole House for detailed scrutiny. The committee stage was completed on 21 December 2011, and the Bill was passed by the Lords, with amendments, on 19 March 2012.[ The Commons agreed to all Lords amendments to the Bill on 20 March 2012. The Bill received Royal Assent and became the Health and Social Care Act 2012 on 27 March 2012.
]
Contents
Parts 1 and 2 Health service in England
Section 9 establishes the National Health Service Commissioning Board, later known as NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
. The Secretary of State is to publish, annually, a document known as the mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to the mandate.
Section 10 establishes Clinical Commissioning Groups which are to arrange the provision of health services in each local area.
Section 11 makes the protection of public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
a duty of the Secretary of State, and section 12 makes local authorities responsible for improving the health of the people in their areas. Among the effects of this, local authorities regained the commissioning of some community services such as those for sexual health
Sexual and reproductive health (SRH) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life.
The term can also be further de ...
and substance misuse.
Section 30 requires each local authority to appoint a director of public health, and gives the Secretary of State certain powers over that person's appointment.
Part 3 Regulation of health and adult social care services
Part 4 NHS foundation trusts & NHS trusts
Part 5 Public involvement and local government
Sections 181 to 189 establish Healthwatch England, responsible for gathering and championing the views of users of health and social care services in order to identify improvements and influence providers' plans.
Sections 194 to 199 establish Health and wellbeing board
Health and wellbeing boards are statutory bodies introduced in England under the Health and Social Care Act 2012, whose role is to promote integrated working among local providers of healthcare and social care.
Establishment
The 2012 Act require ...
s in each upper-tier local authority, in order to encourage providers of health and social care to work in an integrated manner.
Part 6 Primary care services
Part 7 Regulation of health and social care workers
Part 8, National Institute for Health and Care Excellence
Sections 232 to 249 expand the role of the National Institute for Health and Clinical Excellence to include social care, re-establishing the body on 1 April 2013 as the National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas:
* the use of health technologies withi ...
(known as NICE). This non-departmental public body
In the United Kingdom, non-departmental public body (NDPB) is a classification applied by the Cabinet Office, Treasury, the Scottish Government and the Northern Ireland Executive to public sector organisations that have a role in the process of n ...
publishes guidance in areas such as the use of new and existing medicines, treatments and procedures, taking into account cost-effectiveness; its scope is NHS services, public health services, and (in England only) social care.
Part 9, Health and adult social care services: information
Part 10, Abolition of public bodies
Sections 278 to 283 abolished the Alcohol Education and Research Council
Alcohol most commonly refers to:
* Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom
* Alcohol (drug), an intoxicant found in alcoholic drinks
Alcohol may also refer to:
Chemicals
* Ethanol, one of s ...
, the Appointments Commission, the National Information Governance Board for Health and Social Care, the National Patient Safety Agency
The National Patient Safety Agency (NPSA) was a special health authority of the National Health Service (NHS) in England. It was established in 2001 to monitor patient safety incidents, including medication and prescribing error reporting, in the ...
, the NHS Institute for Innovation and Improvement and the standing advisory committees.
Parts 11 and 12, Miscellaneous
Sections 284 to 309 contained various other provisions.
Public reactions
General
On 19 January 2012 two major unions of healthcare professionals that had previously tried to work with the government on the bill, the Royal College of Nursing
The Royal College of Nursing (RCN) is a registered trade union in the United Kingdom for those in the profession of nursing. It was founded in 1916, receiving its royal charter in 1928. Queen Elizabeth II was the patron until her death in 2022. ...
and the Royal College of Midwives
The Royal College of Midwives (RCM) is a British midwives organisation founded in 1881 by Louisa Hubbard and Zepherina Veitch. It has existed under its present name since 1947, and is the United Kingdom's only trade union or professional organis ...
, decided instead to join with the British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
in "outright opposition" to the bill. On 3 February 2012 the Royal College of General Practitioners
The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners (GPs/ Family Physicians/ Primary Care Physicians) in the United Kingdom. The RCGP represents and supports GPs on key issues including ...
also called on the Prime Minister to withdraw the bill.
The Confederation of British Industry
The Confederation of British Industry (CBI) is a UK business organisation, which in total claims to speak for 190,000 businesses, this is made up of around 1,500 direct members and 188,500 non-members. The non members are represented through the 1 ...
supported the bill, declaring that "Allowing the best provider to deliver healthcare services, whether they are a private company or a charity, will spur innovation and choice."[
In May 2011, a number of doctors from GP consortia wrote a letter to the '']Daily Telegraph
Daily or The Daily may refer to:
Journalism
* Daily newspaper, newspaper issued on five to seven day of most weeks
* ''The Daily'' (podcast), a podcast by ''The New York Times''
* ''The Daily'' (News Corporation), a defunct US-based iPad new ...
'' in which they expressed their support for the bill, calling its plans "a natural conclusion of the GP commissioning role that began with fundholding in the 1990s and, more recently, of the previous government's agenda of GP polysystems and practice-based commissioning". On 14 May 2011, ''The Guardian
''The Guardian'' is a British daily newspaper. It was founded in 1821 as ''The Manchester Guardian'', and changed its name in 1959. Along with its sister papers ''The Observer'' and ''The Guardian Weekly'', ''The Guardian'' is part of the Gu ...
'' published an article reporting that the GP appointed to head the NHS "listening exercise" has unilaterally condemned the bill. The article said that Steve Field had "dismissed" the plans "as unworkable" and that these statements were "provisional conclusions that could fatally undermine the plans". The Royal College of General Practitioners
The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners (GPs/ Family Physicians/ Primary Care Physicians) in the United Kingdom. The RCGP represents and supports GPs on key issues including ...
(RCGP) also denounced the bill.
The Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
and Royal College of Surgeons
The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations a ...
[ welcomed ''in principle'' the idea of medical professionals determining the direction of NHS services, but questioned the Bill's implementation of the principle, particularly in regard to the approach of making GP consortia the primary commissioning deciders, and also in regard to requiring competition. The ]British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
said similarly.[ Neither of these organisations supported the bill.
In February 2011 David Bennett, newly appointed Chair of ]Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
, said the NHS could become like other privatised utilities, so that Monitor would potentially be a regulator like Ofcom
The Office of Communications, commonly known as Ofcom, is the government-approved regulatory and competition authority for the broadcasting, telecommunications and postal industries of the United Kingdom.
Ofcom has wide-ranging powers acros ...
, Ofgem
, type = Non-ministerial government department
, nativename =
, nativename_a =
, nativename_r =
, logo = Ofgem logo.svg
, logo_width = 124px
, logo_caption =
, seal =
, seal_width =
, seal_caption =
, picture =
, picture_widt ...
and Ofwat
The Water Services Regulation Authority, or Ofwat, is the body responsible for economic regulation of the privatised water and sewerage industry in England and Wales. Ofwat's main statutory duties include protecting the interests of consumers, secu ...
: "We, in the UK, have done this in other sectors before. We did it in gas, we did it in power, we did it in telecoms €¦We've done it in rail, we've done it in water, so there's actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation." The House of Commons Select Committee on Health condemned the comparison as not "accurate or helpful."
GPs as commissioners
The bill intended to make general practitioners the direct overseers of NHS funds, rather than having those funds channelled through neighbourhood- and region-based primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s, as was previously done.
There were concerns about fragmentation of the NHS and a loss of coordination and planning. The Royal College of General Practitioners
The Royal College of General Practitioners (RCGP) is the professional body for general (medical) practitioners (GPs/ Family Physicians/ Primary Care Physicians) in the United Kingdom. The RCGP represents and supports GPs on key issues including ...
said it was "concerned that some of the types of choice outlined in the government's proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple comorbidities and the frail and elderly."[ The ]Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
said that "Whilst we welcome the broad provision in the bill to seek professional expertise, the RCP is concerned that the bill does not require that specialists are at the heart of the commissioning process."[ The ]Royal College of Psychiatrists
The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental health ...
said it "would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of mental health services."[ The ]Royal College of Surgeons
The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations a ...
said that "the legislation leaves the question of regional level commissioning unanswered with no intermediary structure put in place."[ And there were concerns about management expertise, particularly by looking at the US. The '']BMJ
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origina ...
'' wrote that
The House of Commons health committee has suggested the government let experts other than the consortia GPs and their direct allies get involved in the running of the consortia, including hospital doctors, public health chiefs, social care staff, and councillors. That idea received some wider support and the government agreed to give it consideration. Those close to Health Secretary Andrew Lansley have said that he is concerned adding too many people to consortia decision-making risks making them too unwieldy."['']BBC #REDIRECT BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
...
accessed 21 April 2011 In 2010 the same committee had gone so far as to declare that "if reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, ''after 20 years of costly failure, the purchaser/provider split may need to be abolished''."