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ABSTRACT - Since the purchaser/provider split was first introduced in the early 1990s, there have been successive attempts to enhance and strengthen the role of commissioners in the English NHS. Their role is to ensure that health services are planned and delivered in a way that meets the interests of patients and taxpayers rather than healthcare providers. The new coalition government has recently set out its proposals to transfer commissioning responsibilities from primary care trusts to a national NHS Commissioning Board and a set of general practice-led commissioning consortia. It is too early to say whether these reforms are likely to transform commissioning and finally place payers, rather than providers, in the driving seat of the NHS. However they unfold they are likely to have a significant impact on healthcare professionals in commissioning, primary care and specialist roles.
KEY WORDS: commissioning, general practice, NHS White Paper, purchaser/provider split
Introduction
In July 2010, the UK's new coalition government published a White Paper laying out its plans to 'liberate' the English NHS.1 If fully implemented the policies could lead to profound changes in the roles of central and local government in relation to the NHS, in the relationships between patients and healthcare professionals and in the nature and landscape of health service provision in England.
One of the most prominent and widely discussed features of the proposed reforms is the plan to transfer responsibility for commissioning NHS services from the 151 primary care trusts (PCTs) currently performing that role to a new national Commissioning Board and a set of local general practice (GP)- led commissioning consortia. At the time of writing full details of the new commissioning system are yet to be laid out. But if the legislation is passed and the policy is implemented as the government intends it will be operational by 2012 and PCTs will be abolished from April 2013. Combined with the planned transfer of public health responsibilities from the NHS to local government and the creation of a more open and diverse market of healthcare providers, these changes will alter the culture and structure of the NHS in very significant ways.
And yet although the announcement of this radical reform of commissioning signals an end to the existing regime, it...