The NHS Plan: a plan for investment, a plan for reform (2000)

The NHS Plan, July 2000

The NHS Plan was published on 1 July 2000. Like the 1989 white paper Working for patients, it represented one of the key milestones in the development of choice and competition in the NHS.

The NHS Plan outlined significant changes to how healthcare in England was to be organised, with the intention of modernising the service. The government committed to large-scale investment in the NHS as well as reforms intended to ensure the increased resources would maximise the potential benefit to the patients and public.

The responsibility for shaping and commissioning care had been given to groups of local doctors and nurses through primary care groups (PCGs). The government outlined plans for PCGs as a successor to the GP fundholder scheme – but which was not voluntary. Increasingly powerful, they would gain primary care trust (PCT) status by April 2004, a date that was later brought forward. The emergence of PCTs was to affect the rest of the administrative structure with the role of health authorities diminishing.

From 1 April 2000 the first 17 PCGs had been given primary care trust (PCT) status. Additionally, the government intended to establish care trusts which would provide greater integration between health and social care. Care trusts would be able to commission and deliver primary and community healthcare as well as social care for older people and other client groups.

The NHS Plan marked an important step in establishing closer relationships between the private sector and the NHS. The government committed to an agreement between private providers and the NHS to make better use of the facilities in the private sector, with a particular focus on collaborative working in elective, critical and intermediate care: ‘For decades there has been a stand-off between the NHS and private sector providers of healthcare. This has to end. Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients.’

The government also committed to developing diagnostic and treatment centres in partnership with the private sector. These centres were intended to separate routine hospital surgery from emergency work to help reduce waiting times. The original intention was to develop 20 diagnostic and treatment centres by 2004, with eight fully operational centres treating approximately 200,000 patients per year.

The plan also referenced the poor system of financial incentives in operation at a hospital level.

The NHS Plan outlined the government’s view that there needed to be additional mechanisms for assuring the quality and safety of services. The NHS Plan committed to:

  • establishing a mandatory reporting scheme for adverse healthcare events by the end of 2001
  • requiring all doctors employed by or under contract to the NHS to participate in annual appraisal and clinical audit from 2001. All doctors working in primary care would be required to be registered with the health authority and would be subject to clinical governance arrangements including annual appraisal and participation in clinical audit
  • establishing a National Clinical Assessment Authority which would provide a rapid and objective expert assessment of an individual doctor’s performance
  • strengthening the regulation of the clinical professions. Self-regulatory bodies would be required to have greater patient and public representation, develop meaningful accountability arrangements and have faster, more transparent procedures
  • establishing a UK Council of Health Regulators to support increased coordination across different regulatory agencies.