The Queen's Speech: Health - Shift to home care as GP groups take control of funding

THE END of the internal market and a radical reshaping of the NHS to put family doctors in the driving seat was heralded yesterday.

The Government announced its intention to introduce an NHS Bill to end competition and make the health service more patient-centred and less dominated by institutions. Billions of pounds will ultimately be transferred to local collectives of GPs and community nurses who will control 90 per cent of the NHS's total resources. Each "Primary Care Group" will number around 50 GPs serving about 100,000 people and will eventually become a Primary Care Trust, holding a single budget for hospital, primary and community care.

The single budget will mean the trusts can decide whether to hire more community nurses so people can be cared for in their homes or spend more on prescribing to control medical conditions rather than sending patients to hospitals or nursing homes where care is expensive.

The aim is to break down the "Berlin walls" between health and community care whose separate budgets mean patients cannot easily be transferred between them. This has led to inappropriate treatment and hospital beds blocked by patients who should be cared for at home.

The NHS Bill will end GP fundholding, under which individual practices hold limited budgets for some hospital care, which the Government believes has led to a two-tier service. However, there are doubts whether the legislation can be passed in time to meet the Government's deadline of 1 April.

The Bill also introduces measures to prevent a repetition of episodes such as the Bristol babies heart scandal. A hit squad will be created with powers to go into failing hospitals and turn them round. Called the Commission for Health Improvement, it is being compared by ministers to Ofsted for teachers and will also have a rolling programme of visits to local NHS organisations. The Bill will also tighten the requirement on drug companies to comply with the Pharmaceutical Price Regulation scheme which controls the cost of drugs to the NHS and has hitherto been voluntary - a measure which shows ministers' growing frustration at the escalating NHS drugs bill.

A second Bill will tighten arrangements for collecting the cost of treating road accident victims from insurance companies which is expected to raise an extra pounds 100m a year for patient care. Hospitals have had the right to claim the money since before the NHS began but many have not bothered because of the paperwork involved. Under the Road Traffic Act (NHS Charges) Bill, the money will be collected centrally by an arm of the Benefits Agency according to a national tariff of charges which the Government says will reflect the "real costs of treatment". The money will be paid by the responsible driver's insurance company.