NHS reorganisation ill-timed but focus must now switch to boosting commissioning, says The King's Fund

Speaking in response to today's Health Select Committee report on changes to primary care trusts, The King's Fund chief executive Niall Dickson said:

'The Health Select Committee is right that this represents a major structural reorganisation of the NHS over a very short period when the health service is struggling to get to grips with all the other major reforms. It was ill-timed and badly executed and just one more thing for the health service to cope with. While many of the proposed changes are sensible in themselves, it was unwise to attempt this at this time and the way it was done was clumsy to say the least.

'But we are where we are and the priority now must be to reform commissioning, which remains the Achilles Heel of the NHS. That means empowering and giving incentives to GP practices or groups of practices to take on commissioning while holding them to account for delivering better outcomes for their patients. The danger is that the new larger primary care trusts will merely be the same animal with bigger boundaries. Instead they need to be something very different - their task should be to create an environment where new organisations grow and to encourage others to undertake commissioning.

'The primary care trusts themselves should be light touch overseers. They should make sure incentives are working effectively to drive up quality; they should be concerned about equity for patients and probity among service providers; and they should be the guarantor that patients in their area have access to high quality care.

'Stronger incentives are needed to engage family doctors in particular to commission effectively and counter the huge forces on hospitals to increase admissions. The health service must become better at reducing avoidable ill health and hospitalisation through cost-effective out-of-hospital care. This should also involve other agencies outside the health care system. We hope this will be the main thread of the government's forthcoming White Paper.'

Notes to editors: 

  1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King's Fund issued a formal response to the Health Select Committee's inquiry into potential changes to primary care trusts' functions and numbers arising from the Department of Health document, Commissioning a Patient-Led NHS, which was issued in June. Consultation response: changes in primary care trusts, a Health Select Committee consultation
  3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities