Lansley sets breakneck schedule for sweeping reforms

By Ian Quinn

The Government has laid down a relentlessly ambitious timeframe for the launch of GP commissioning.

Under the White Paper timetable, all GP federations will be expected to have been formally established by autumn 2012, with them due to take on full responsibility for commissioning the following financial year.

It sets out plans for a ‘comprehensive system of GP consortia' to be in place in ‘shadow form' by the end of 2012, taking on increased delegated responsibility from PCTs.

The NHS Commissioning Board will make allocations for 2013/14 budgets going direct to consortia in late 2012, with GP consortia taking ‘full financial responsibility' from April 2013.

Mr Lansley said the Government had ‘deliberately developed a strategy as quickly as we could,' although the NHS Alliance had called for the plans to be scaled back, claiming only a small fraction of GPs were ready to take on responsibility.

Pulse revealed last week that the Alliance had called for the strategy to be trialed in pilot areas first, although other groups such as the NAPC have been pushing for a much swifter rollout.

NHS chief executive Sir David Nicholson, who at the recent NHS Confederation Conference had expressed serious doubts about the commissioning ability of GPs, suggesting the timeframe was wildly ambitious, appeared to have changed his mind when appearing alongside Mr Lansley at today's press conference.

He described the document as a ‘very clear and coherent vision for the future.'

July 2010 - Further publications on:
• framework for transition
• NHS outcomes framework
• commissioning for patients
• local democratic legitimacy in health
• freeing providers and economic regulation

Summer 2010 - Report of the arm's length bodies review published

Autumn 2010 - Health Bill introduced in Parliament

By end of 2010 - Further publications on:
• vision for adult social care
• information strategy
• patient choice
• a provider-led education and training
• review of data returns
- Separation of SHAs' commissioning and provider oversight functions

Late 2010 - Public Health White Paper

From 2011 - Introduction of choice for:
• care for long-term conditions
• diagnostic testing, and post-diagnosis

2011 - White Paper on social care reform

By April 2011 - Choice of consultant-led team

April 2011 - Shadow NHS Commissioning Board established as a special health authority
- Arrangements to support shadow health and wellbeing partnerships begin to be put in place
- Quality accounts expanded to all providers of NHS care
- cancer Drug Fund established

From April 2011 - Choice of treatment and provider in some mental health services
- Improved outcomes from NHS Outcomes Framework
- Expand validity, collection and use of PROMs
- Develop pathway tariffs for use by commissioners

June 2011 - Quality accounts: nationally comparable information published

By July 2011 - Report on the funding of long-term care and support

Summer 2011 - Hospitals required to be open about mistakes

2011/12 - GP consortia established in shadow form

2011/12 - Tariffs:
• Adult mental health currencies developed
• National currencies introduced for critical care
• Further incentives to reduce avoidable readmissions
• Best-practice tariffs introduced for interventional radiology, day-case surgery for breast surgery, hernia repairs, and some orthopaedic surgery

By April 2012 - NHS Outcomes Framework fully implemented

April 2012 - Majority of reforms come into effect:
• NHS Commissioning Board fully established
• New local authority health and wellbeing boards in place
• Limits on the ability of the Secretary of State to micromanage and intervene
• Public record of all meetings between the Board and the Secretary of State
• Public Health Service in place, with ring-fenced budget and local health improvement led by Directors of Public Health in local authorities
• NICE put on a firmer statutory footing
• HealthWatch established
• Monitor established as economic regulator

2012/13 - International Classification of Disease (ICD) 10 clinical diagnosis coding system introduced

Autumn 2012 - NHS Commissioning Board makes allocations for 2013/14 direct to GP consortia

2012 - Free choice of GP practice
- Formal establishment of all GP consortia

2012/13 - SHAs are abolished

April 2013 - GP consortia hold contracts with providers

From April 2013 - PCTs are abolished

2013/14 - All NHS trusts become, or are part of, foundation trusts
- All providers subject to Monitor regulation

By 2013/14
- Choice of treatment and provider for patients in the vast majority of NHS-funded services
- Introduction of value-based approach to the way that drug companies are paid for NHS medicines

By end 2014 - NHS management costs reduced by over 45%

By July 2015 - NICE expected to produce 150 quality standards