Planned NHS changes are happening in Norfolk already

The bill to transform the NHS may have only just been published, but the plans are already being put into place in Norfolk. Kim Briscoe reports.

The government said a patient-centred NHS was a 'step closer to reality' as it published its plans for a radical overhaul of the health service.

The health and social care bill will see all 152 of England's primary care trusts (PCTs) scrapped alongside 10 strategic health authorities.

GPs will be given around 80pc of the NHS budget – currently topping �100bn a year – to commission services for patients.

In Great Yarmouth and Waveney, 26 GP practices were already working together as a practice-based commissioning group, so it was a relatively simple matter for them to decide to continue that as HealthEast Community Interest Company (CIC), a non-profit making, social enterprise company.

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Andy Evans, chief executive for HealthEast, said because the consortium fitted neatly with just one primary care trust, NHS Great Yarmouth and Waveney, it made the process much easier.

He said: 'We are already leading on the negotiation for community services. We haven't got to dip our toe in because we're already up to our waists.'

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Not all of the GP groups are so far advanced, but hard on their heels are the North Norfolk Health Consortium and a consortium in West Norfolk.

The plan is for consortia in Norfolk to start to take over some services in the coming year with the help of the PCTs, then in 2012-13 they will be leading with support from PCT, ahead of taking over completely in April 2013, which is when the PCTs will be scrapped.

Ian Mack, NHS Norfolk's clinical executive committee chairman, said the idea was to strip out bureaucracy and 'top down' targets, and replace them with local solutions.

He said: 'An organisation led by clinicians and GPs will be flexible about how to deliver healthcare to improve health outcomes for their area. There's much greater autonomy for what they can do.'

Dr Mack said work was already taking place to provide better healthcare for north Norfolk's older patients, with case managers to support individuals, while Thetford had focused on teenage pregnancy and sexual health.

The cost of implementing the changes is �1.4bn, but Health Secretary Andrew Lansley insisted they would save the NHS more than �5bn by 2014/15 and �1.7bn every year thereafter.

Nationally, 24,500 jobs are expected to go, but it's difficult to put a figure on things locally. It's thought that some of the 500-plus experienced staff working in commissioning for organisations like NHS Norfolk and NHS Great Yarmouth and Waveney will find new roles within the GP consortia.

Documents accompanying the bill outline how between 50pc and 70pc of SHA and PCT staff are likely to be retained and employed by the NHS commissioning board and the GP consortia.

But until the GPs have worked out what sort of staff they will want to employ, it's hard to tell how many redundancies there will be. There are likely to be a small amount of job losses in the coming months. PCTs have been told to 'cluster' and we are likely to find out at the end of February if NHS Great Yarmouth and Waveney will join forces with NHS Norfolk or NHS Suffolk. The merger will mean downsizing from two executive teams to just one.

But the national plans have come under fierce attack from health unions and doctors' leaders worried that the reforms are 'too much too soon'.

There has been widespread concern over measures to increase competition between NHS providers and private companies.

The timing of the reforms has also been questioned – the NHS is currently trying to find �15bn to �20bn in efficiency savings.

Critics say the reforms could lead to a postcode lottery in which patients living in one area are denied a treatment provided to their neighbours. 'There is a danger of that,' says Mr Evans, 'but we will have to take note of national best practice and work with other consortia to try to avoid this happening.'

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