s. They recognised that a further, major upheaval would not be popular amongst healthcare workers, who had only just got used to the last changes. They were also keen to avoid accusations from the Conservatives that they were simply trying to turn back the clock.Late in 1997 the Labour Party policy was crystallised into a new white paper for England called 'The New NHS'. Scotland, meanwhile, had always had a different system for its NHS in any case but with the imminent arrival of a devolved Scottish parliament a separate white paper (along the same lines) called 'Designed to Care' was published.The government wishes to see six principles upheld. The NHS should be:a national service providing consistently high quality, prompt and accessible services driven by local doctors and nurses characterised by partnership, not competition efficient focused on excellence and quality a public service, accountable to patients and shaped by their views To achieve this, the total NHS budget will be divided among Health Authorities who in turn will pass the money to primary care groups (PCG) each made up of around 50 GPs. In time, these PCGs will be encouraged to assume complete control of all commissioning/purchasing decisions, and Health Authorities will merge to cover larger populations.Annual contracts between purchasers and providers will be replaced with three- to five- year agreements. The social and clinical services will be encouraged to work together, instead of using the boundary between each other to resist referrals and thereby contain costs. Measures including common budgets will be considered, and ideas are to be piloted in a number of 'Health Action Zones'.As promised, Fund holding was stopped from April 1999 and replaced entirely by PCGs. Hospital and Community Trusts continue as before, but they are strongly encouraged to devolve budgetary responsibility to clinical teams, and to involve senior professionals more in management. Contra...
