'The NHS improvement plan: putting people at the heart of public services' white paper

In June 2004, the government published its white paper the NHS improvement plan: putting people at the heart of public services.

The white paper outlined the government's priorities for the NHS between 2004–08, building on the 2000 NHS Plan. In it, the government confirmed there would be continued investment in order to increase capacity across the system.

The white paper set out an ambition that by 2008 all hospital trusts would be in a position to apply for NHS foundation trust status. There was a strong focus on freeing providers from the control of Whitehall and an emphasis on 'earned autonomy' for good performers and decentralisation.

The plan also made a commitment that by 2008, no one would have to wait longer than 18 weeks from GP referral to hospital treatment, and most people would experience much shorter waits, with even quicker access in priority areas such as cancer.

Providers, assessment and incentives

The government outlined its expectation that by 2008, the independent sector would be providing up to 15% of NHS services. The white paper suggested that there would be fewer national targets and reduced monitoring, and outlined that the newly established Healthcare Commission would inspect all providers, whether in the NHS or in the independent sector.

The commission would also have responsibility for developing criteria for assessing provider quality and would take on responsibility for the annual assessment of NHS providers via performance ratings.

The government also recognised the important role that GP practices played in commissioning services for their patients and local populations. It committed to developing models of practice-level commissioning with SHAs, PCTs and GPs, and stated that by April 2005, all GP practices would be able to ask for indicative budgets. This was intended to give GPs additional incentives to manage referrals appropriately.

The plan asserted that the health care system needed to develop in order to accommodate the use of financial incentives, and that the use of payment by results (PBR) would be extended to non-hospital services and would be based on a single national tariff.

The plan outlined new contractual arrangements that would be available to primary care trusts (PCTs) to commission primary care more flexibly, such as the introduction of the Alternative Provider Medical Services (APMS) contract, which would provide opportunities for new entrants into the primary care market.

The plan also outlined the need to focus more attention on PCT development to ensure PCTs would be able to realise the potential of commissioning.

Promoting independence

In his statement to the House of Commons regarding the NHS Improvement Plan, John Reid made a commitment that by 2008 every patient referred by their GP would be able to choose to be treated by any facility that met NHS standards and could offer care at NHS pricing.

The plan also set out the government's vision for social care services: users were to be given greater control over their own care with services personalised to their needs. The government outlined that services needed to be person-centred, and the plan committed to expanding access to direct payments to all those who were eligible.

The government stated that there needed to be a greater focus on proactive and preventative service planning and delivery to prevent crises and support people to retain their independence. The plan envisioned improved integration and communication between social care and health services, thereby offering a better and seamless service to users.

Public health capacity

The government stated that it would place a greater emphasis on public health and the prioritisation of preventative health measures. It acknowledged that there was a need to strengthen public health capacity and delivery systems and to have the right people placed in health and local government, equipped to work on public health.

The government believed that there needed to be a more robust information-sharing system as well as a better evidence base on the most effective and cost-effective interventions. The government committed to improving its support for public health interventions at local and cross-departmental levels.


In March 2005, Creating a patient-led NHS: delivering the NHS improvement plan was published in order to provide further detail regarding the plan's implementation. Primary care trusts (PCTs) would be required to offer a selection of four or five local providers for acute and elective services from 2006.

The government made it clear that the relationship between PCTs and local authorities was integral to ensuring effective commissioning and service delivery. PCTs would be expected to be involved in local strategic partnerships and the development of local area agreements in order to develop joint planning and commissioning. Funding for providers would be determined by patient choice and tariff payments.

The document discussed practice-based commissioning and its potential to incentivise GP practices to invest in the health of their patients. PBC would enable practices to offer more in-house services and would allow commissioning decisions to be based on local and individual needs.


HM Government.
The NHS improvement plan: putting people at the heart of public services.
HMSO; 2004.

House of Commons.
NHS Improvement Plan: HC Deb 24 June 2004 vol 422 cc1451-69
Hansard; 2004.