Frank Dobson, Secretary of State for Health, set out a ten year strategy for the health service in the NHS White Paper. The strategy is centred around structural changes and a range of measures to improve standards of care.Standards will be raised by the creation of two new national bodies and the introduction of a 24 hour advice service. The National Institute for Clinical Effectiveness, will promote high quality guidelines for treatment, based on the best evidence. The Commission for Health Improvement will raise standards of care by making sure that all parts of the NHS learn from, and are brought up to, the standards of the very best.
The advice service, to be known as NHS Direct, will offer round the clock information and advice to callers who cannot see their GP or visit the accident and emergency department of their hospital. The advice line will be staffed by nurses. The hot line scheme has been adapted from private health care and the United States. It has reduced doctor’s home visits and demands on hospital beds.
The major changes relate to a shift in health care focus from hospitals to the community and to the way care is commissioned. The changes will be introduced in April 1999. The internal marked is being replaced by a system of integrated care that will put doctors and nurses in the driving seat. It is estimated that the change will save Â£1b.
The commissioning of care will be taken over by primary care groups led by GPs and community nurses, each representing communities of about 100,000 people. They will replace commissioning by fundholders and health authorities. Annual contracts between fundholders or health authorities will be replaced by long term, possibly 3 year, service agreements. The new arrangement will give a degree of power to the commissioning groups to impose disciplines on the providers, because there will be an opportunity to switch to another provider. This power will also curb the influence of the big hospitals to drive the health service.