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The NHS Reorganisation Act 1973

The NHS Reorganisation Act 1973 received royal assent on 5 July 1973 and gave effect to the reforms outlined in the white paper National Health Service reorganisation: England. The act reformed the tripartite structure of the NHS established by the National Health Service Act 1946. Previously, there had been separate administrative structures for:

  • hospital services (administered by regional hospital boards, hospital management committees and boards of governors)
  • family practitioner services (administered by executive councils)
  • personal health services (administered by local authorities and including services such as health visiting, maternity services, vaccination and ambulance services). 

The act brought together the above functions into one unified structure of NHS administration and gave the secretary of state for health and social security responsibility for school health.

The reorganisation of the NHS structures was intended:

  • to unify the health service
  • to facilitate better cooperation between health and local authorities, and
  • to achieve better management through detailing and making clear the functions of each tier of the system.

The act abolished regional hospital boards and hospital management committees and most, but not all, teaching hospital boards of governors (six specialist London postgraduate hospitals and the Hammersmith Hospital were not placed under RHAs but were instead given special health authority status). These were then replaced with regional health authorities (RHAs) and area health authorities (AHAs), which were to be established by order of the secretary of state. RHAs were able to delegate functions to AHAs, which had a duty to comply with directions. Some AHAs were multi-district, some single district and each district centred on a district general hospital. It was at district level that the work of hospital management was done, creating an additional administrative tier within the AHA.

AHAs were required to set up family practitioner committees (FPCs). FPCs, on behalf of AHAs, were to provide general medical services (as well as dental, pharmaceutical and ophthalmic services).

AHAs were matched with local government boundaries and the act placed an obligation on health authorities and local authorities to cooperate with each other in their bid to ‘to secure and advance the health and welfare of the people in England and Wales’. Joint consultative committees were established to advise AHAs and local authorities on the performance of their duties under the act, and the planning and operation of services that were of common concern to both authorities.

The act also established Community Health Councils for each AHA area to represent the interests of patients and the public in health services.