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Government reveals fundamental changes to health bill

By Gareth Iacobucci

GP consortia will be re-branded as 'clinical commissioning groups', will have to appoint at least one nurse and one hospital consultant onto their boards, and will have to share boundaries with local authorities, as part of a wide-ranging shake-up of the Government's NHS reforms.

The Government today set out in detail the areas of the legislation it plans to revise following yesterday's Future Forum report, conducted during the two month ‘pause' to the Health and Social Care Bill. (Read the Government's full response to the NHS Future Forum here.)

GP leaders have welcomed the changes. That include a lifting of the April 2013 deadline for GPs to take on full commissioning responsibility. No firm new deadline has been set; however, all GPs in England will have to be members of a shadow commissioning group by April 2013.

Where commissioning groups are not able to take on full responsibility by April 2013, local arms of the NHS Commissioning Board will commissioning on behalf of the shadow groups. The report says 'the NHS Commissioning Board will work with the GP practices and other stakeholders in these areas to develop fully operational commissioning groups and hand over commissioning responsibility to them as they become ready, so that we move, over time, to avoid a two-tier system of commissioning in the NHS.'

The changes also include a beefed-up role for the new 'clinical senates' of doctors, nurses, other professionals, and health and wellbeing boards, additional safeguards against privatisation, a revised role for Monitor that stipulates its core duty is to ‘protect and promote patients' interests', and a more phased approach to the introduction of Any Qualified Provider.

The Government also pledged to revise plans for the controversial quality premium, to ‘make clear that its purpose is to reward clinical commissioning groups that commission effectively and so improve the quality of patient care and the outcomes', and said it would change the bill 'to make provisions for how commissioning groups can use any quality payment awarded to them'.

Prime Minister David Cameron said: 'The fundamentals of our plans are as strong today as they have ever been, but the shape of our plans have changed as a result of this consultation.'

‘We've listened, we've learnt and we are improving our plans for the NHS.'

Deputy Prime Minister Nick Clegg hailed the changes which had been made, following extensive Liberal Democrat opposition to parts of the bill.

‘You were worried about privitisation through the back door – so we have made that impossible,' he said. ‘We have made it illegal to favour the private sector, or in fact any other provider over another.'

And he also welcomed the increased role other healthcare professionals will play in the rebranded 'clinical commissioning groups'. Significantly, the requirement for each group to have a nurse and a hospital consultant on its governing body was not among the NHS Future Forum's recommendations published yesterday.

Mr Clegg said: ‘GPs are an important part of the answer – but not all of it.'

Dr Clare Gerada, RCGP chair said she was 'pleased' the Government was addressing some of the college's concerns over the health reforms.

She said: 'As family doctors, we know that patients want their care to be provided closer to home through the NHS and through GPs working in partnership with hospital and social care colleagues. We must now work together with Government to celebrate the successes of the current NHS whilst evolving to meet the needs of patients in the future.'

BMA chair Dr Hamish Meldrum said the changes 'puts the reforms on a better track'.

He said: There is much in the Government's response that addresses the BMA's concerns, and many of the principles outlined reflect changes we have called for. The success of the reforms will very much depend on how the various elements link together and work on a practical level, and on how much they engage clinicians and patients locally.'

The key changes

- To reflect stronger emphasis on wider professional involvement in commissioning decisions, the term 'clinical commissioning group' will be used to describe these local NHS organisations.

- Consortia boundaries should not normally cross those of local authorities, with any departure needing to be clearly justified.

- Consortia will have to include at least one registered nurse and one doctor who is a secondary care specialist. They must have no conflict of interest in relation to the clinical commissioning group's responsibilities, e.g. must not be employed by a local provider.

- By April 2013, GP practices will be members of either an authorised clinical commissioning group, or a ‘shadow' commissioning group, i.e. one that is legally established but operating only in shadow form, with the NHS Commissioning Board commissioning on its behalf.

- Clinical commissioning groups that are ready and willing by April 2013 could be authorised to take on full budgetary responsibility. Some will only be authorised in part. Others will only be established in shadow form. This will be determined through a robust process of authorisation, run by the NHS Commissioning Board, with input from emerging Health and Wellbeing Boards and local clinicians.

- The Government will revise the provisions in the Bill on the quality premium to ‘make clear that its purpose is to reward clinical commissioning groups that commission effectively and so improve the quality of patient care and the outcomes this leads to, including reducing inequalities in health outcomes'. There will, however, be circumstances where it would clearly not be appropriate to award a premium, for instance if a commissioning group has achieved high-quality outcomes by spending more than the money allotted to it and thereby compromising the resources available to other parts of the country. The Government will change the Bill so that regulations can be used to make provisions for how commissioning groups can use any quality payment awarded to them.

- Clinical senates will have a formal role in the authorisation of clinical commissioning groups. In addition they will have a key role in advising the NHS Commissioning Board on whether commissioning plans are clinically robust and on major service changes.

- The Government will maintain its commitment to extending patients' choice of "Any Qualified Provider", but we will do this in a much more phased way, and will delay starting until April 2012.

Read the full response

To read the Government's full response to the NHS Future Forum report, please click here.

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