All change

Spring 2011 

Jo Clarke from Macmillan’s policy team discusses proposed changes to the NHS and what impact these may have on cancer care.

Within weeks of coming to power in May last year, Health Secretary Andrew Lansley had published his plan to ‘liberate the NHS’ from ‘excessive bureaucracy and top-down control’, and put power in the hands of patients and front-line staff.

His white paper, Equity and excellence: Liberating the NHS|, is underpinned by three principles: to put patients at the heart of the NHS; to focus on outcomes, not process targets; and to empower clinicians.

GP commissioning

A key feature of the reforms, and perhaps the most controversial to date, is the plan to scrap strategic health authorities (SHAs) and primary care trusts (PCTs) and hand responsibility for NHS budgets and commissioning to GPs in 2013.

Moving the responsibility to GPs, the government says, will bring decision-making and control of resources closer to patients, ensuring that commissioning decisions are underpinned by clinical insight and knowledge of local healthcare needs.

The plan

The idea is that GP practices will come together in ‘consortia’ to commission services for their local population. How many GP practices will be in each consortium has not yet been decided, and the government has said that those decisions should be taken locally. In the pilots, one consortium has only three practices in it, while another has 105.

The Government doesn’t think that GPs will be actively involved in every aspect of commissioning. GPs will lead the clinical design of local services, and buy in support for managerial tasks, like dealing with provider contracts. However, some are concerned that budgets for this support are being slashed, with GPs only getting half of what PCTs currently do for management.

Commissioning for cancer is complex

There are many different types of cancer requiring many different types of treatment and care. Cancer also cuts across many different services, which need to be coordinated along the care pathway. Commissioning cancer pathways will therefore be a real challenge for the new GP commissioners.

At the moment, PCTs get support for cancer commissioning from experts within cancer networks, however the government has said funding for networks will end in April 2012.

Charities, including Macmillan, have been asking the government to consider the effect this will have on cancer commissioning, and asking for other commissioning support structures to be put in place to help GPs.

Outcomes, not targets

Another big shift is the scrapping of ‘top-down targets’ in favour of measuring patient outcomes. Under the Labour government, the NHS was set a number of targets that it had to meet to show it was performing effectively. These included things like GPs having to see patients within 48 hours, and patients being treated within 18 weeks of GP referral.

The new government says that these targets distorted behaviour and distracted attention from the ultimate goal of improving patient outcomes. They have instead produced an ‘Outcomes Framework|’ [PDF, 1007kb], which includes measures like ‘five-year cancer survival rates’. The government says clinicians should be trusted to make the right decisions for their patients on how improvement in these areas can be achieved.

Waiting time targets for cancer treatment| are the exceptions to this rule, however. The government has recognised that these have helped to drive service improvement and have been beneficial for patients, and so these will remain.

What happens next?

The government’s plans have to be discussed in parliament before they can become law. Despite the controversy and opposition from many within the health sector, it’s likely these major shifts will happen.