Devolving to the frontline

Health minister John Hutton has announced a new drive to devolve more power to frontline NHS workers.

The measures, which have not been widely consulted on, will have "implications for the entire health service", according to the NHS Confederation.

The government is unveiling plans which will lead to GP practices directly commissioning care and services "tailored to the specific needs of their patients".

From April 2005, practices will be able to receive an "indicative budget" from primary care trusts (PCTs) that they can use to improve the delivery of services.

While PCTs themselves will continue to be legally responsible for the contracting process.

But any savings which result from managing referrals more efficiently will be shared between practices and PCTs, with all of those savings being reinvested into patient care.

Hutton confirmed that targets will be set for the numbers of practices to become involved in "practice led commissioning" - though practices will be encouraged to respond to it at their own pace.

The minister claimed the new approach will result in patients benefiting from a greater variety of services from a larger number of providers in settings that are closer to home or more convenient for them.

"This will enable GP practices and other groups to play a bigger role in commissioning services for their patients and local populations," he said.

"It will mean greater flexibility for GPs to deliver services tailored to their patients' needs.

"Money freed through Practice Led Commissioning will be ploughed back into the delivery of patient services, therefore increasing investment in primary care."

The proposals outlined by Hutton will be "road-tested" with the NHS over the next few weeks.

Nigel Edwards, director of Policy at the NHS Confederation, says the government must be careful to avoid repeating past mistakes.

"This is a very significant policy development which has implications for the entire NHS. Like any complex change, it would benefit from more discussion with those responsible for implementation," he said.

"In particular, we need to incorporate the lessons of previous experiments in practice-led commissioning, which have proved to be all incentive and no sanction - practices that under-spend can keep the surplus, whereas those who over-spend are allowed to rely on PCTs to pick up the tab."