There are 2 very important changes that signal the end of the NHS.
The first is the free for all for Commissioning consortia. Historically PCTs have covered a geographical area and have been responsible for care of all the people in that area. PCTs are to be replaced with commissioning consortia. The Royal College of General Practitioners, based on international studies of similar organisations said that they should have a minimum of 300 000 patients in order to have a sufficient economy of scale to effectively commission the range of services their patient’s need. Many doctors warned that they should be co-terminous with local authorities and responsible for a geographically defined area. The government have allowed anyone to set up a consortia. There is a list of consortia here. In london they range from 7 to 67 practices in size. They are not obliged to cover a geographic area.This allows GPs to select the most efficient practices and avoid the least efficient.
The second important change is the loss of GP boundaries, now set for April 2012. Spun as patient choice, this may allow GPs to choose patients. Patients who are housebound or have long-term serious illness are much less likely or able to choose a practice that is not very close to them. The patients who will be looking for a practice away from home will be the young, fit and mobile. Business minded practices will be looking to register these patients because they earn money for registering them, but they do not incur costs caring for them. By contrast, a very sick patient incurs a lot of costs because of time for home visits, prescription costs, nursing time, hospital admissions and so on. I have written about practice boundaries here.
The combination of selecting practices and patients and the abandonment of the duty to provide care for a defined area is a MASSIVE change in how the NHS works. In the very near future, patients will register with a consortium to be entitled to the services the consortium provide and have commissioned.
This sets in place perfectly the structure for commissioning consortia to form Health Management Organisations (HMOs), the US insurance companies that select patients and set fees according to risk. Yesterday Mike Birtwistle blogged about the underlying conservative committment to converting the NHS to this system,
Many on the Conservative right believe that any reforms which do not lead to a move towards insurance-based healthcare should be decried for their timidity. You only need to read a Reform report on health to realise that this strand of thinking is alive and well and very attractive to certain sections of the Party.
Colin Leys and Stuart Player warned about it in their book, The Plot Against the NHS.
Update 27.01.2012 CCGs further widen health inequalities
How many more warnings do we need?
A Better NHS 
A frightening prospect. Why is this not being given more publicity such as a discussion on Newsnight or other national news?
@Julia
Part of the reason why this is not being covered more widely is because these two principles were policies of all three parties, they only differed in their implementation. “GP Choice” was explicitly mentioned in all three main parties’ manifestos.
Journalists only report what they think are newsworthy. If everyone agrees then there is no newsworthiness.
but it is newsworthy to the public , their criterion is wrong
Thank you for this very helpful piece.
@Julia: I have been particularly concerned about the GP boundary issue for some time, and also struck by total lack of journalists’ critique. The trouble is that almost everyone thinks being able to choose your GP, anywhere in England (!), can’t be a bad thing. They do not consider the consequences of this choice. That is why I started my blog.
@Richard Blogger: Yes, you are right. The issue is not sexy, at least not for the moment. But when we get closer to implementation and GPs then make their opposition more public, then things might get interesting. The LMC conference were unanimous in bidding the GPC to staunchly resist this policy when negotiating with the government. If this debate then becomes topical, my hope is that a light will be shone on it and then the journalists will look more closely at the underlying complexities. And, hopefully, at the hidden agendas as well.
I support the boundary changes primarily because there are no small practices where I live, at all. Our village Surgey which was 2 doctors has been taken over by a large 16/17 doctor practice in Marlow. We only have the choice of this one Surgery. The village is outside all the local GP Surgery boundaries. I really do need a small practice. I am fortunate in that a single handed GP who I have worked as a health campaigner kindly offered to take me as a patient however he is some distance away. So I will also have to pay for a private GP to support this so I have a doctor closer to home. There just are no suitable Surgery’s where I live.