The white paper Our health, our care, our say: a new direction for community services was published on 30 January 2006. The white paper set out four aims:
- providing better prevention services with early interventions
- giving people more choice and a greater voice
- tackling inequalities and improving access to community care services
- providing more support for people with long-term conditions.
It proposed to fulfil these aims by:
- giving GPs more responsibility for local health budgets (practice-based commissioning)
- exploring changes to the payment by results tariff to incentivise changes
- piloting individual budgets
- focusing on prevention
- offering more community services and care at home
- developing a joint commissioning framework for health and wellbeing
- encouraging innovation and quality through the use of direct payments and individual budgets
- allowing different providers to compete for service delivery.
The white paper outlined the government’s desire to offer patients the choice of GP practice (although choice was limited by catchment area) alongside existing reforms to empower GPs to commission services for their registered patients (practice-based commissioning) which had been introduced from 2005.
If the public has a choice of practices, then those that offer the most appropriate and responsive services will attract more patients. Practices will have to identify and meet the cultural and demographic needs of the population they serve – they will have to design services around the user in order to attract them.
Practice-based commissioning (PBC) gave practices indicative budgets and the government hoped this scheme would increase the involvement of clinicians in commissioning. However, PBC didn’t take off in the same way that GP fundholding did.
One of the main objectives of the white paper was to give people ‘more choice and a louder voice’. Alongside the commitment to offer patients registration onto a local GP practice list, the paper outlined plans to increase the information available to the public and plans to incentivise GP practices to offer patient-centred opening times.
The white paper also reflected on competition, suggesting that barriers to entry for third-sector service providers for primary care should be removed and highlighting the potential of social enterprise (using business disciplines for social objectives with a re-investment of profits).
The white paper outlined the establishment of a Third Sector Commissioning Task Force and a Social Enterprise Unit within the Department of Health which would provide funding (from April 2007) to support the development of new models of care provided by the voluntary sector.
The government proposed to conduct pilots over 18–24 months for individual budgets for older and disabled adults. If successful, the government would roll out implementation by 2009-10.
The white paper made it clear that there needed to be improved coordination between the commissioning of health services and the commissioning of social care. The government committed to:
- improving local leadership, joint commissioning and joint working by strengthening the roles of directors of public health and directors of adult social services
- rolling out local area agreements (LAAs) to all local authorities by 2006/7. LAAs were made up of indicators and outcomes by which local performance on improving quality of life would be measured.