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Summer may be over but the heat is still on for the NHS

Marilyn Eveleigh
Consultant Editor

It started with the Department of Health's publication Commissioning a Patient-led NHS in March 2005. It was a challenge for changes to be made in the way NHS services were designed and provided to patients. It promised more locally tuned services, and local spending for commissioning those services. It put GPs and their teams in charge of determining the care they want to provide for their patients. It promised that nursing teams would be able to secure the services their housebound patients needed. It made clear that private providers, charitable and voluntary organisations and independent bodies would be welcome to provide patient services alongside or instead of those traditionally provided by the NHS. Patient choice is key - choice of providers of care, choice of which hospital to go to, and locally based choices.
How such changes would come about were revealed this summer - and the heat began to rise. So, what changes are we to expect?
There is to be a major reorganisation and reduction of primary care trusts (which are not even five years old yet). These organisations decide and commission patient services for an area as well as provide a range of community services such as district nursing. In future they will split the two functions. There will be mergers of PCTs into those that commission services for patients. These commissioning PCTs will be bigger and more geographically diverse, but they will be supporting and managing the decisions made at local general practices for what patients need: practice-led commissioning.
Provider PCTs will offer NHS healthcare services that commissioning PCTs may wish to buy for their local population. There will be amalgamations of PCT community nursing teams and services. Staff will have new NHS (and maybe non-NHS) employers. There will be a wider range of providers of primary care services to choose from, as previously mentioned. No longer will the NHS be a monopoly provider of healthcare - but healthcare will remain free at the point of delivery. Closer links of community health teams with social services and local authorities will be a bonus but will require new adjustments and understanding to deliver seamless patient/client services.
Sound like good ideas? There has been a backlash from NHS leaders to such rapid, radical and further NHS reorganisation. The announcement has already brought unrest and uncertainty for frontline staff involved in mergers. Reducing administration and management costs is a target and will create pressures within the service.  
And what of the new provider options? The Guardian newspaper at the end of September carried an appeal from key healthcare opinion leaders, clinicians, MPs and previous government ministers to stop the privatisation and fragmentation of the NHS, saying NHS funds should stay within the NHS. There is further debate to be had on this one … Where there is change, there is always anxiety and stress, and the NHS is reeling from more change with an already stressed workforce. This mood will take us into winter - will it give rise to more discontent?  
Be alert to the impact it will have on your role - but seize the opportunities that come with change. Those of you who have seen previous NHS reorganisations will need to provide the stability that change threatens - patients deserve as little disruption as possible. But then again, dedicated healthcare staff deserve consideration too.