quences. strings for most health-care services, also deliver a range of community, mental health and primary care services. They employ upwards of 250,000 health workers. provision of services "reduced to a minimum." plans to be drawn up not by patients or health workers, but by Strategic Health Autgorities, with little or no public discussion. end of November. million). responsibility. be involved in practice-based commissioning by 2008." hospital care, diverting more patients to private providers and native forms of 'care outside of hospital.'
So the biggest losers are the hospital trusts, which are excluded from any aspect of the planning or commissioning process, and facing a drastic reduction in income. Many are next spring. serious application to the regulator. For information and ammunition to fight back against cuts and privatisation see www.healthemergency.org.uk and www.keepourNASpublic.com A new circular "Commissioning a patient-led NHS' was sent out by NHS Chief Executive Sir Nigel Crisp on July 28: it has hardly been reported in the national press, but it will have far-reaching consePrimary Care Trusts (PCTs) which currently hold the purse
Crisp's latest plan would mean that PCTs will have to be broken up and reduced to commissioning only, with their role in direct
It is not at all clear how this will be done - services may be hived off to existing trusts, privatised or handed to the voluntary sector. PCTs also face the prospect of mergers - on the basis of
Sir Nigel's July 28 circular gave the SHAs until October 15 to submit proposals - which will then be vetted by the Department of Health and, in some cases, then put out to "consultation" at the
SHAs themselves may also face mergers, even though there are only 28 of them in England covering large areas and populations. One of the targets of the new reforms is to cut management and administrative spending by a minimum of 15 per cent (E250
Meanwhile, in the same circular, pressure is being brought to bear on PCTs to ensure that the commissioning of all contracts for services is transferred to groups of GP practices "no later than the end of 2006." It's not at all clear that GPs want this additional
The new policy is the direct opposite of the Department of Health's own guidance just seven months earlier that there are no targets - we simply have the aspiration that all practices will
The whole restructuring is designed to cut spending on NHS encouraging GPs and PCTs to free up' cash by developing alterfacing huge problems as a result of long-term deficits, to be compounded by a new system of 'payment by results' to be introduced
The July 28 circular insists that trusts must now be pressganged by SHAs down the road of foundation trust status, despite the fact that many are carrying deficits which would rule out any