Autonomy, accountability and democratic legitimacy

The reforms set out in the health White Paper Equity and Excellence: liberating the NHS are intended to ‘liberate professionals and providers from top-down control’ and to locate the headquarters of the NHS ‘in the consulting room and the clinic’.

Under the proposals currently set out in the Health and Social Care Bill 2011, every GP practice will have to join a Clinical Commissioning Group (CCG). These will be created as new statutory bodies, with a ‘maximum management allowance’ and an accountable officer. The NHS Commissioning Board will allocate budgets to CCGs and hold them to account for their use of resources and the outcomes they achieve. In turn, the Secretary of State will hold the NHS Commissioning Board to account in maintaining financial control and on delivering improvements in  choice and patient involvement.

Within local authorities, statutory ‘health and wellbeing boards’ will be responsible for ensuring that the commissioning of NHS services, social care and health improvement is joined up. The powers that enable joint working between the NHS and local authorities will be extended.

All existing NHS trusts will be supported to become foundation trusts, with the opportunity to become ‘employee-led social enterprises’. Employers will have the right to determine pay for their own staff (as foundation trusts do currently).

Monitor and the Care Quality Commission (CQC) will run a joint licensing programme for all providers of NHS care to ensure continuity of services and to maintain essential levels of quality and safety.

We've produced a number of resources on the topics covered in this section of the White Paper, and have listed some of the key pieces of commentary and analysis below:

Commissioning resources

A guide to GP commissioning in England

This short briefing gives an outline of GPs’ role in commissioning in England to date and highlights evidence from The King’s Fund and others on the impact of different commissioning models. (Article, October 2010) 

GP commissioning: making it happen

Our latest conference explored the challenges of establishing effective GP commissioning with keynote speaker Lord Howe. (Event, September 2010)

The White Paper challenge for GPs

Most GPs will tell you that their primary duty lies with caring for their patients. But how does this core value sit with the new responsibilities set out in the NHS White Paper? (Blog, September 2010)

The principles of GP commissioning: general practices and the rationing dilemma

Nick Goodwin examines the dilemma of GP commissioning in light of The British Medical Association's GPs Committee 'fundamental principles' – its first position statement on the controversial flagship policy of the coalition government. (Blog, August 2010)

GP Inquiry: Commissioning and general practice

The Inquiry into the Quality of General Practice in England will be looking at commissioning in general practice to impact on their final report. (Project, 2010)

Building high-quality commissioning: What role can external organisations play?

This report examines how external support is being used by primary care trusts and strategic health authorities and whether it is helping them to develop more effective commissioning. (Publication, July 2010)

The King's Fund's response to the NHS White Paper

Giving GPs budgets for commissioning care and managing NHS budgets should result in services becoming more closely aligned with patients' needs. Read the full response to the White Paper. (Press release, July 2010)

Giving GPs budgets for commissioning: What needs to be done?

This joint briefing paper explores what needs to happen if GPs are to be given real power and responsibility for leading commissioning in the NHS. (Publication, June 2010)

What future for world class commissioning?

If commissioning in England is to become world class, GP consortia will need to work together with PCTs, private sector firms and external organisations in an effective, cost-efficient way. (Blog, June 2010)

GP-led commissioning: quality is key

With the coalition government embarking on the most radical changes to the NHS seen in decades, Nick Goodwin discusses what the future of general practice should look like. (Article, June 2010)

Further information and commentary on commissioning

Governance, regulation and accountability resources

Freeing the NHS from politics

Will the proposal of an NHS Independent Board deliver the promise of reduced politicisation and increased autonomy for the NHS? (Blog, May 2010)

Accountability of foundation trusts in the English NHS

This article maps and describes the formal accountability relationships of foundation trusts in England and explores the interpretations of these relationships. (Article, April 2010)

Accounting for quality to the local community

This publication assesses how far current plans for quality accounts meet the need to increase NHS accountability by making more information about quality available to the public. (Publication, April 2010)

Further information and resources on governance, regulation and accountability

Competition and co-operation resources

The White Paper: Will peer review improve performance for GP consortia?

Will the pressure of competition between health care providers, and patient choice lead to an increase in performance and quality? (Blog, July 2010)

Creating employee-owned organisations in the NHS: engaging and empowering NHS staff

Questions are being raised around how employee ownership can be used to give NHS staff greater ownership and control over their work, how services are delivered and how their organisation is run. Find out more with our presentations and podcasts from this recent event. (Event, June 2010)

Who should own the NHS?

During the election all three of the main political parties were keen to praise co-operative, employee-owned organisations. But just how would these models work in the NHS? (Blog, April 2010)

Improving partnership working to reduce health inequalities

What general practices of co-operation could help the NHS to facilitate and create better partnerships? (Article, December 2009)

Lord Carter of Coles on co-operation and competition

Lord Carter of Coles speaks about his role as Chair of the Co-operation and Competition Panel, and discusses the panel's work. (Video, October 2009)

Further information and resources on co-operation and competition