Sir Keir Starmer announced a radical and highly significant move this week when he scrapped NHS England, the body which has been responsible for the daily running of the NHS in England since 2012. But what does this mean for primary care, and what might the effect be - if any - on patients?

Bonfire of the Quangos?

NHSE had recently swallowed up NHS Digital, and Health Education England, making it a very large body of the type known as QUANGOS (Quasi-Autonomous Non-Governmental Organisations). The rationale behind its abolition is: clear to save money and cut bureaucracy. For too long, red tape has seen to be stifling innovation. Bringing decisions back into the Department of Health and Social Care (DHSC) control may allow more autonomy to be devolved to local Integrated Care Boards, as well as local authorities.

The writing seemed to be on the wall following the Darzi report’s conclusion that focus needed to move away from acute care back to General Practice. The message is: only primary care can solve the problems that beset the NHS. To do that, as much money and resource will need to be saved and funnelled to it as possible.

One concern, however, is whether the DHSC has enough staff with the medical expertise to understand General Practice and be able to really support future contract negotiations with doctors. Ministers will be expected to “own” the business-as-usual problems the NHS is experiencing. If it’s done right, it could be transformative. If it fails, an already bad situation could be made worse.

It’s thought that to fully implement this change will take at least 2 years. When tangible changes to the patient experience will come is less certain.

Job Losses, But Monetary Savings

Few will mourn the abolition of layers of middle managers. Current estimates are that around 9,000 jobs will be lost as a result of the move, across NHSE and the DHSC. The likely savings estimate of at least £500m is seen as too important an opportunity to miss, however.

However, despite ICBs being impacted and likely becoming more important now, this week the NHS itself asked ICBs to cut their “administrative” workforce by 50% (some 12,500 staff in all, realising a saving of £700-£750m). More detail is said to coming on this in the 10-year plan, which is eagerly awaited and scheduled to be revealed in May this year.  

Neighbourhood Watch

This is part of the broader key theme of ‘neighbourhood’ which the Labour government and the NHS is keen to embed. The idea is that local bodies know better the needs and demographics of their local populations. The phrase “Neighbourhood Health Service” has become increasingly popular, underpinning the shifts of ‘hospital to community’, and ‘sickness to prevention’.

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