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Last Updated: Wednesday, 24 March, 2004, 17:29 GMT
How the NHS reforms affect patients
The reforms aim to improve patient care
A raft of NHS reforms come into effect on 1 April. They include new contracts for doctors and more freedom for top-rated hospitals.

BBC News Online examines what the changes will mean for patients.

This week, the government launches a four-pronged offensive to modernise the NHS.

It will increase the pay and overhaul the working conditions of thousands of GPs and hospital consultants.

It will give some of England's top rated hospital trusts more freedom than ever before.

It will set up a new inspection watchdog to drive through improvements across the health service.

And it will accompany these reforms with a massive injection of cash.

But what, if anything, will it mean for patients?

New contracts

Extra pay and new contracts for doctors may, on the face of it, be expected to have little impact on patients.

However, they have the potential to radically change the way patients experience the NHS.

The GP contract
Spending on primary care will rise by one third
GPs will be able to opt-out of providing care at evenings and weekends
Their pay will be linked to the quality of care they provide
Some will be able to opt-out of providing non-essential services
Many expected to provide additional specialist services
For instance, under the terms of the new GP contract the government will increase spending on primary care by one third over the next four years.

While some of this extra money will go to doctors, some of it is earmarked for extra staff and additional services.

Practices will be expected to recruit more nurses so that GPs can spend longer with patients who really need their attention.

Some GPs are expected to offer extra services, such as minor surgery, normally only available in hospitals.

The consultant contract
Consultants to get pay rises of 9% and 24%
Working week will be 40 hours per week
Extra money to work evenings and weekends
New rules on when they can work in private sector
Many are also expected to hand over responsibility for looking after patients after hours to local health chiefs.

In some areas, this could see nurses providing the bulk of the care to patients at evenings and weekends.

The consultant contract is also designed to benefit patients.

Under their deal, consultants can be offered extra money to hold clinics or carry out operations in the evenings and at weekends.

The government hopes this will enable hospitals to carry out more operations and cut the length of time patients have to wait for treatment.

"It's good for doctors and good for patients," says Dr Paul Miller of the British Medical Association.

Foundation trusts

The launch of the first wave of foundation trusts is important in political terms, as the government lets go of some of its apron strings.

Foundation Trusts
A new type of not-for-profit independent hospital
Will have more freedom from government control
Will be able to set their own clinical priorities
Will be able to raise extra money by taking out loans
Will be expected to come up with innovative ways to cut waiting times
These hospitals will have much more freedom from Whitehall control. They will be able to set their own priorities and decide how best to spend their money.

But proponents say these changes will benefit patients.

"We hope it will help us to move faster and more responsively to the needs of patients," says Fran Harper, who is leading efforts to secure foundation status for Addenbrooke's NHS Trust in Cambridge.

"This could mean extra capacity. It could mean more theatres, more wards and a nicer environment for patients."

However, opponents say the policy will create a two-tier health service, with the best hospitals benefiting from more freedom and extra money while the not-so-good languish and fall further behind.

Powerful watchdog

The new, all-powerful watchdog, the Healthcare Commission, will open its doors on 1 April.

It replaces the Commission for Health Improvement and the National Care Standards Commission.

It will also take over some of the work currently done by the Audit Commission and is lined up to take over from the Mental Health Act Commission too.

The new watchdog will be expected to play a key role in driving up quality across the health service.

All of these reforms are been backed with a record amount of government cash.

Overall spending on the NHS will increase from 72bn to 79bn.

"All of these reforms are designed to improve patient care," says Professor Edward Peck, director of the Health Services Management Centre at Birmingham University.

"They are designed to make people feel that the NHS can be as responsive as the private sector. Some of them are quite brave.

"We will have to see if they will have the effect the government wants."

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