UK government spells out new plan for NHS in England.

1329 Nigel Hawkes LONDON GP commissioning consortiums in England will be obliged to include two lay members, a hospital specialist, and a nurse on their boards, the government has announced. Their name will be changed from GP or GP led consortiums to “clinical commissioning groups,” and they will be required to meet in public and publish their minutes. To avoid conflicts of interest the nurse and specialist cannot be employed by local NHS providers, the government says in its response to the report of the Future Forum, the body it set up to elicit responses to its Health and Social Care Bill in the wake of charges that the bill would destroy the NHS. While in most respects the government has accepted the forum’s recommendations, in this instance it has gone further by insisting on board level representation of other groups. The forum, chaired by Steve Field, former chairman of the Royal College of General Practitioners, produced a series of recommendations that the government has accepted. These include changes to the role of Monitor, which was charged under the bill with promoting competition. This duty will be removed, and Monitor’s role will be restricted to tackling abuses “that demonstrably act against patients’ interests.” The government has not committed itself to another recommendation of the forum: that patients should have the right to challenge poor services. It says that it will carry out further work on whether this idea is feasible. But it has accepted the proposal for “clinical senates,” groups that will bring together doctors, nurses, and other professionals to give expert advice to the clinical commissioning groups. The senates will have a formal role in authorising the commissioning groups and advising the national NHS Commissioning Board whether plans are clinically robust. The government denies that this will be a new layer of bureaucracy, saying that the senates (together with the existing clinical networks) will be housed by the NHS Commissioning Board. Health and wellbeing boards will also have the power to object to the establishment of a commissioning group. In line with forum regulations, the government has agreed to relax the reform timetable, with the blanket deadline for NHS trusts to become foundation trusts by April 2014 lifted. By April 2013 all general practices will be part of a clinical commissioning group or of a “shadow” group—one that is formed but has yet to take on full responsibility. No option exists for practices to opt out of commissioning altogether; but for those that are not ready by April 2013 the NHS Commissioning Board will deputise. The forum reserved its strongest words for the section of the bill that has caused least controversy, that on education and training. This area needs to be given a lot more thought, the forum concluded. With the abolition of the strategic health authorities, postgraduate deaneries urgently need a home and reassurance of a continuing role. The government accepts this advice, saying that deaneries will continue to oversee training and will have a clear home within the NHS family. Most of the forum’s recommendations neatly split the difference between the health secretary, Andrew Lansley, and his critics.