The major reorganisation of the NHS has been put into practice this week, as family doctors taker the reins of commissioning health services in England.
There are a number of big changes for the NHS - and none bigger than the abolition of the 151 Primary Care Trusts and Strategic Health Authorities, which have now been replaced by 211 Clinical Commissioning Groups.
The CCGs, which are being run by GPs with the help of hospitals doctors and specialist nurses, will take on around £65 billion of the NHS budget, with the NHS England (formerly the NHS Commissioning Board) taking the other £30 billion for specialised commissioning.
NHS England, which is being headed up by Sir David Nicholson, will also be responsible for the new CCGs.
But there have also been other changes, including NICE’s new remit, which will see it take on responsibility for assessing the cost-effectiveness of orphan medicines.
This used to be the remit of the Advisory Group for National Specialised Services (AGNSS), but from this week NICE will take on the responsibility for high cost, low volume medicines. It will also publish new guidance for social care for the first time, and continue its work expanding HTAS overseas with NICE International.
As well as NICE expanding, there will also be a greater focus on community care in the NHS with a phased move away from the reliance on hospitals, especially for long-term care in conditions such as dementia and diabetes.
But not all have been happy with the reforms; responding on Twitter to the changes, Gary Hepburn, a medic and consultant, said: “New arrangements and CCG’s are a retrograde step; how can you make contractors to NHS responsible for commissioning.”
A recent British Medical Journal found that one in every three GPs on the new local boards has a financial ‘conflict of interest’. Many of these hold shares in large private-sector health firms, which are competing for financially lucrative contracts from GP commissioning groups.
Writing in the Daily Mail last month, Dr Ben Goldacre argued against the reforms, saying that the Royal College of General Practitioners warned in 2011 that this new system posed “huge ethical risks”.
He wrote: “It’s one thing if doctors really are corrupt, and filling their pockets. But as the College warned: even if people only believe that their doctor might be thinking of their own income, then the reputational consequences for the medical profession will still be dire.”
Mike Farrar, chief executive of the NHS Confederation, which represents PCT and SHA managers, said that people in the NHS “really want the new system to be a success”, but warned it “can’t be set up to fail”.
He also reiterated that the NHS finances were still the major concerns as it faces “an unprecedented financial challenge” and also tries to rebuild public confidence following the failings in care at Mid Staffordshire NHS Foundation Trust.
The Confederation told PharmaTimes UK News that despite that abolition of the groups it represents, it will still continue its role of representing managers in the NHS, and has aligned itself with the ‘NHS Clinical Commissioners’, a new membership group for CCGs, fronted by the NHS Alliance’s Dr Michael Dixon.
The Confederation added, however, that the changes in the NHS mean it will longer have a Primary Care Trust Network within the Confederation.