27 April 2001
Launched to opposition claims that it was a pre-election rabbit out of the hat, the move heralds the most radical shake-up of health service management in decades.
Milburn, under fire from hospital doctors and GPs, said he wanted to create a 'flatter' NHS structure that would put more power in clinicians' hands. By 2004, he pledged to restructure England's 99 health authorities into around 30 strategic agencies with powers to performance-manage primary care trusts. These GP-led bodies would receive funding directly from the Department of Health. The new NHS Modernisation Agency will oversee the changes.
GPs are angry over their administrative workload and what they perceive to be government stalling over a new contract. They will be polled by the British Medical Association on their willingness to resign over the matter and the results will be announced in June.
The BMA has already advised GPs to stop carrying out some administrative tasks and even to stop registering new patients. Some GPs are planning protests on the May Day bank holiday.
The health secretary hopes his plans, which will give PCTs control of three-quarters of NHS spending in England, will boost GP morale and avert further embarrassment to the government. Although there would be national standards and targets, PCTs would be given a large degree of autonomy in order to foster a 'culture of public sector enterprise'.
Milburn said he wanted 'to make it more worthwhile for local health services to innovate in the way they deliver care to patients. This requires more local discretion over how budgets are spent.'
Hospital doctors, who are angry over a proposed new contract which would prevent new consultants from performing private work for seven years, could also gain direct control over funding.
'I believe we can put the country's top cancer specialists in charge of the budgets for all cancer patients. Other local innovations to put frontline staff in charge of services will be encouraged too,' he added.
BMA chairman Ian Bogle welcomed the devolution of power to doctors but warned that the plans could exacerbate one of the major causes of low morale.
'Anything that involves taking doctors away from their patients is going to increase the workforce and workload problems that are already there. Local decision-making will only work if generous resources are provided locally to allow that process to happen,' he said.
Stephen Thornton, the NHS Confederation's chief executive, said the changes were sensible. But he added: 'The money saved from reducing the number of health authorities needs to be ploughed back into supporting doctors, nurses and managers in PCTs.'
Milburn's reforms will almost certainly mean the abolition of the NHS Executive, the department's management arm.
Work carried out in the executive's eight regional offices will be transferred to the enlarged health authorities. For example, trusts will be accountable to the new authorities, rather than the regional offices.
PFapr2001
