Health secretary Alan Johnson says he is confident GPs can be persuaded to provide the additional services proposed in Lord Darzi's review of the NHS, published this morning.But he made clear that the private sector would also be a part of moves to set up 150 new walk-in centres and increase GP provision in the areas facing the greatest shortage of doctors.

The interim report by the junior health minister was published today at a training session for the 72 'clinical champions' who will do much of the groundwork for the final report, due next year.

Prime minister Gordon Brown made a surprise appearance at the event. 'You will find his report a compelling vision of the future in which quality is now central to everything that we do,' he said.

Expanding access

Lord Darzi's report said the relationship between low life expectancy in deprived areas and a shortage of family doctors was 'clearly unacceptable'.

He called on the government, which has accepted all his recommendations, to invest in bringing at least 100 new GP practices into the 25 per cent of primary care trusts with the poorest provision.

Speaking at the report's publication, Mr Johnson said: 'This is going to happen. There's a role for the private sector here as there's a role for the rest of the NHS.'

He said he was confident GPs could be persuaded to work in under-doctored areas and out of hours without 'tearing up the GP contract'.

But the incentives that will be offered to doctors are not yet clear.

'I do not think it will take a lot of enticing in the sense that if the money is there and the investment is there for the contracts and we are training lots of doctors coming through the centres, it's where the jobs will be,' Mr Johnson told HSJ.

Lord Darzi said money should also be made available to enable PCTs to set up 150 GP-led health centres 'situated in easily accessible locations' where patients could access walk-in services from 8am-8pm, seven days a week, whether or not they were registered there.

Private providers such as Virgin, Boots and Lloydspharmacy are believed to be positioning themselves to take on many of these contracts.

Funding

The cost of the proposals has not been revealed. Ministers said this would be announced after the comprehensive spending review, which HSJ can reveal is now planned for Tuesday.

Mr Johnson said today he was 'optimistic about getting a fair settlement for health' in the spending review.

Reconfiguration

Lord Darzi's report proposed raising the burden of proof for reconfiguration proposals.

'We should ensure that any major change in the pattern of local NHS hospital services is clinically led and locally accountable by publishing new guidelines to make clear that change should only be initiated when there is a clear and strong clinical basis for doing so,' the report said.

Consultation on reconfiguration proposals should only proceed 'where there is effective and early engagement with the public'.

And proposals to change services would be subject to independent clinical and managerial assessment before consultation through the Office of Government Commerce's gateway review process, it said.

Choice

The report reintroduces the term 'choice' - largely absent from ministers' rhetoric since Gordon Brown became prime minister.

Lord Darzi says choice must be extended beyond elective care to primary care services and for patients with long-term conditions.

Tackling infections

Following Mr Brown's recent emphasis on patient safety, the surgeon also recommends introducing MRSA screening for all elective admissions from next year and for all emergency admissions 'as soon as practicable'.

NHS constitution

Lord Darzi has asked NHS chief executive David Nicholson to chair a working group to consider the scope for a constitution for the service.

'I have come to the view that the NHS could benefit from greater distance from the day-to-day thrust of the political process,' he says in the report.

Final report

The final report will be published next June, in time for the NHS's 60th anniversary in July. Each strategic health authority will feed in its conclusions on how the quality of care can be improved locally.

These regional reports will be based on work by 72 clinical champions - eight in each region, with each focusing on the following areas:

  • maternity and newborn care;

  • children's health;

  • planned care;

  • mental health;

  • staying healthy;

  • long-term conditions;

  • acute care;

  • end-of-life care.

To read the full interim report, click here

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