This site is intended for health professionals only

Coalition applies its give and take approach to NHS

The key Tory pledge for a bonfire of targets is dropped, but it's a policy both sides agree on that could prove most controversial of all, says Pulse editor Richard Hoey

Well, I wrote last week that the Tories and Lib Dems had some hard work ahead of them to reconcile their differences on the NHS… but perhaps I was underestimating the energy levels of this hyperactive bunch.

The two parties have today published their comprehensive coalition agreement ahead of schedule, and on the health service as with many other areas have shown the flexibility that is becoming this Government's trademark.

An independent NHS board looked like it could conflict with locally elected primary care organisations, but they both make the mix, albeit with the Lib Dem plan scaled back to include only some elected members.

The GP contract is to be rewritten, and the Conservatives appear to have agreed that it should include incentives to improve care in deprived areas, as the Lib Dems had suggested.

The Conservatives meanwhile had pledged a sweeping cull of NHS targets, but appear to have agreed to drop that promise, with the joint document saying only that frontline staff will be ‘given more control of their working environment'.

Lib Dem nervousness over the effects of abandoning waiting targets appears to have won through. And the party's caution over GP commissioning does seem to be reflected in the document too.

It says: ‘We will strengthen the power of GPs as patients' expert guides through the health system by enabling them to commission care on their behalf.' But does that mean hard budgets and a contractual responsibility to commission?

Still, there were some areas of NHS policy where the coalition partners always were broadly in agreement, and these are the areas pretty cast-iron certain to happen.

Health quangos are to be ‘cut significantly' – I wonder whether the little-loved National Prescribing Centre and National Patient Safety Agency could be first for the chop, as I suggested last year?

But GPs will read the pledge to give ‘every patient the right to choose to register with the GP they want, without being restricted by where they live' with a familiar dread.

Practice boundaries really are facing the axe then, as both parties' manifestos promised, even though Nigel Edwards, director of policy at the NHS Confederation, told me last week that the policy was a red herring.

There must have been plenty of lively discussions during the health policy negotiations, but it could be a policy that both parties agree on that will prove most controversial of all.

Richard Hoey, Pulse editor