This week the Government is publishing its proposals for a radical shake-up of the NHS. Health editor Barry Nelson answers some common questions thrown up.

Q WHAT are the main proposals contained in the Health Bill?

A The coalition Government wants to simplify the structure of the NHS and give more power to grassroots GPs.

This will involve the abolition of two tiers of management, including 151 primary care trusts (PCTs) and regional strategic health authorities (SHAs).

Currently, about 80 per cent of the budget for health care is held by PCTs.

Health Secretary Andrew Lansley wants to hand over about £70bn of NHS funding to groups, or consortia of GPs, who will become responsible for planning and purchasing healthcare provided by GPs, hospitals and mental health units.

This will happen in two years time when PCTs and SHAs will be abolished. At the same time, the Government plans to give NHS hospitals greater freedom to compete with private health firms and social enterprises (not-forprofit companies set up by groups of healthcare workers) in providing a range of services.

An Independent Health Board will also be set up to set standards, hold GPs to account and fund specialist services such as dentistry.>[?

Q WHAT has happened in the North-East and North Yorkshire so far?>[?

A IN December, the Department of Health announced that three clusters of GPs in the North-East were among 52 in England to be named as pathfinders. The biggest cluster in the region is the County Durham and Darlington Federation Pathfinder Group, which includes all 90 GP practices in the area.

The two other consortia in the first wave of pathfinders were the Newcastle Bridges group of 18 practices and the Langbaurgh group of 16 practices covering Redcar and Cleveland.

The pathfinder clusters have begun testing the new commissioning arrangements before they take full control of NHS budgets in 2013.

Two more North-East pathfinder clusters, in Gateshead and Northumberland, were announced yesterday.

Dr Stewart Findlay, spokesman for the new County Durham and Darlington Federation Pathfinder Group, has said he and his colleagues are looking forward to working with other colleagues in secondary care and in local authorities to help shape the future of the NHS in the region.

Two more pathfinder clusters, in Hambleton and Richmondshire, and in Harrogate and Rural District, were also announced yesterday.

Q WHY is the Government doing this when patient satisfaction with the NHS is at an all-time high?

A DESPITE the improved performance of the NHS in recent years – thanks to a massive cash injection – Mr Lansley believes there is still scope to increase the quality of services provided to patients.

His view is that GPs have the best interests of their patients at heart and, because of their position at the centre of the NHS system, they are best placed to make decisions on how NHS funds should be allocated.

He also believes in encouraging greater competition in the NHS by allowing private firms and social enterprises to bid for contracts.

Mr Lansley is also convinced that there is too much bureaucracy in the NHS and money needs to be concentrated on front-line services.

Q WHO is objecting to the plans and why?

A IN a letter to The Times newspaper, the chairman of the British Medical Association (BMA), Hamish Meldrum, Royal College of Nursing chief executive Peter Carter and the heads of health trade unions including Unison and Unite, criticised the scale and speed of the Government’s proposed health reforms.

They said the changes risked undermining patient care by putting cost before quality.

At the weekend, the NHS Confederation, the body which represents all NHS organisations including PCTs and hospitals, warned that the Government’s plan to allow GP clusters to buy services from any willing provider could lead to the closure of some hospitals or other facilities.

Some academics have questioned whether it makes sense to hand over such a lot of public money to what are in essence private businesses.

Few people realise that GPs are selfemployed rather than being employees of the health service.

Q HAS the idea of allowing GPs to effectively run the NHS been tried before?

A DURING the John Major government in the Nineties, the Conservatives created GP fundholding.

This allowed local GPs to take charge of elements of local budget.

Only about half of all English doctors took part in this scheme and the budget only involved paying for knee and hip replacements.

Labour took an axe to fundholding when they came to power in 1997 because they thought it was divisive, but a version of the fundholding scheme called practice-based commissioning was introduced within a few years. It was not well supported by most GPs.

Q IS this all about saving money?

A WITH massive public spending cuts across the board, any reduction of costs in the Health Service would be welcomed by the Government, as long as it did not affect frontline care for patients. The NHS has been ordered to make up to £20bn savings by 2014. Mr Lansley hopes that by dramatically reducing management costs in the NHS he can save money without undermining patient care.

Some critics have pointed out that the reforms themselves will cost millions to implement and the GP clusters will need to take on staff to help them manage budgets.

Q DID the reforms have to be so wideranging?

Could the system have been tweaked to produce similar results?

A MR LANSLEY insists that the reforms are necessary because GPs can play a key role in improving the NHS, but the two organisations representing doctors – the BMA and the Royal College of GPs – have both said that the same results could have been achieved by simply increasing the number of GPs who sit on the board of PCTs.