Darzi set to put commissioning at centre stage

Bridging the two will be an expanded National Institute for Health and Clinical Excellence.

The report is set to link funding to what patients think of services and enshrine patient choice in law with a constitution.

In his vision for the next 10 years of the NHS, health minister and surgeon Lord Darzi is expected to focus on raising the quality of services, preventing ill health, empowering staff and giving patients greater control over care.

The NHS constitution will be published alongside Lord Darzi's report on Monday, with separate strategies on primary and community care, workforce issues and informatics on subsequent days.

The government is hoping the next stage review will be seen as the successor to the 2000 NHS Plan.

Health secretary Alan Johnson has said the review will be "the most important development in the history of the NHS".

Primary care and commissioning

Primary care is likely to be the central focus, running through the majority of the report and underpinning a service in which it plays a greater role through commissioning and prevention. This is expected to be a precursor to more integration of primary and secondary care.

The government is to reiterate its commitment to local decision making on service organisation and configuration based on clinical evidence.

But with greater local freedom will be clearer national standards on the quality of services.

NICE will expand to take on some of this role from the government. It is expected to make recommendations on the adoption of new technologies and care pathways in addition to its existing recommendations on drugs and treatments.

For the first time the government is expected to make clear its commitment to scrapping the minimum practice income guarantee but not to impose its removal on GPs.

Lord Darzi will state that the guarantee is not producing good outcomes for patients, works against patient choice and undermines efforts to tackle health inequalities. It is one area of reforming the GP contract that the government will negotiate with the British Medical Association following the report.

Reform of primary care provision will see changes to the finance regime, including development of a payment by results tariff for community services.

Integration of care

As revealed by HSJ, Lord Darzi will announce integrated care pilots. There are expected to be 15, testing a variety of models. However, more complex ones - for instance allowing foundation trusts to provide GP services - are likely to require primary legislation.

Primary care trusts will be told to come up with a plan for their provider arms by the autumn.

HSJ understands recommendations on boosting public involvement in PCTs will be included, following debates during the review of various models, such as foundation trust-style membership.

Quality

An increasing role for patient reported outcome measures will be just one element of a major focus in the report on quality. Lord Darzi is expected to announce plans to progressively link funding to the measures. NHS managers will be able to decide whether they want to link outcomes to staff pay.

Acute providers will see a firm commitment to introducing normative pricing in payment by results. The tariff paid would reflect the most efficient rather than the average cost for some treatments.

Constitution

The constitution is expected to summarise what patients and staff can expect from the NHS by setting out their rights and responsibilities. For example, it is likely to give the public rights on waiting times or access to facilities.

It is thought patients will be given a legal right to choice, with an obligation on NHS organisations to provide choice whenever it is clinically appropriate.

Healthcare managers believe the government will have been careful to ensure it does not leave itself open to litigation.

A senior Whitehall source said: "Alan and Ara [Darzi] are determined that it will be neither a lawyers' charter nor a meaningless document and it will have real force in NHS organisations, but not to the point where it infringes on their ability to make sensible, well organised decisions."

The constitution will be put out to consultation.

Workforce

The workforce report will address leadership skills, particularly clinicians', as well as education, staff well-being and training.

Training is particularly important as Lord Darzi's report will prompt questions over the ability of managers - particularly middle managers - to deliver his vision.

However, the report is thought to be unlikely to back Sir John Tooke's recommendation for a national body with responsibility and budgets for medical training in England.

A more popular policy would be to coach clinicians and non-clinical managers together on improving quality and safety standards.

The report will call for PCTs to play a bigger role in deciding what their local workforce looks like, and they could take over some strategic health authority responsibilities.

Reference will be made to the new NHS performance regime, with a proposal for the definition of "failure" to take into account measures such as staff satisfaction and the quality of a trust's employees.

Lord Darzi's report is expected to announce "pension passports" allowing NHS staff who transfer to social enterprises to keep their NHS pensions.

In effect, such arrangements already exist for not-for-profit companies and for-profit companies owned by groups of NHS clinicians. But the move could exacerbate bad feeling within the corporate sector.

A Department of Health source admitted a solution for corporate providers was "a long way off". One way forward being explored by the Treasury is to establish a fund to reimburse private providers for pension costs required to match the NHS scheme.

This would help level the playing field when PCTs select providers but could be controversial if seen as a subsidy for the private sector.

Informatics

The informatics review - completed by interim chief information officer Matthew Swindells before he left the DH in April - will be published the week after Lord Darzi's report.

The DH is understood to have addressed previous criticism of the way informatics were managed across health and social care with a reform of NHS Connecting for Health's management structure.

The final report is expected to underline how better information can support patient choice. A source said it would attempt to help patients make knowledgeable choices without having to defer to their GP for advice.

Patients

Lord Darzi is expected to announce the introduction of individual budgets for patients. It is understood there will be£20m available for pilot schemes allowing patients with long-term conditions such as MS or who require NHS continuing care to shop around for their treatments.

For full coverage of Lord Darzi's report see next week's HSJ.

HSJ's Implementing Our NHS, Our Future conference is on 8 July.