Welsh white paper outlines different GP structure plus role for Assembly

Launching Putting Patients First in Cardiff, Welsh health minister Win Griffiths claimed pounds10m a year would be saved by 'getting rid of the paperchase of the internal market' and trust reconfiguration, adding up to pounds50m over the present parliament's lifetime.

But Dave Galligan, Unison head of health in Wales, described this figure as 'think of a number, double it and add zero'.

He added: 'Even then, it is supremely optimistic. There are going to be more people in the purchasing loop and I do not see how that is going to save money.'

Morton Warner, director of the Welsh Institute of Health and Social Care, said he was surprised more prominence was not given to the role of nurses, mental health and learning disability services, and health action zone- type schemes. 'They are still insisting that pounds5m-pounds10m a year can be saved from trust reconfiguration,' he said. 'I do not know where they get that from. Our work suggests reconfiguration could actually cost money.'

The Welsh white paper has the same 'broad thrust' as its English equivalent, The New NHS: modern, dependable, launched six weeks ago.

It retains the purchaser-provider split in secondary care, but emphasises 'collaboration' rather than 'competition' between different health organisations. It says a new quality framework will be drawn up to improve services, and promises that, by the end of the year, women with suspected breast cancer will be seen by a specialist within five days of GP referral and receive hospital test results within another five days.

GPs and other primary care professionals will be given a bigger role in commissioning services for patients, but there will be no primary care groups in Wales.

Instead, local health groups will be created that are coterminous with Wales' 22 unitary authorities. Initially, these will be sub-groups of HAs, and primary care trusts are unlikely to be established in Wales.

Bob Broughton, British Medical Association Welsh secretary, said: 'I think doctors in Wales probably see the more cautious approach as a welcome thing because the last set of reforms was implemented before they had been properly thought through.'

Putting Patients First says all five Welsh HAs will be retained. They will have to draw up five-year health improvement programmes for their areas and will be given new powers to ensure trusts and local health groups act within them.

But the white paper says the Welsh Assembly will assess the needs of local populations, distribute resources and monitor the health organisations' performance, leading Mr Galligan to predict: 'HAs will become redundant, perhaps in as little as five years'.

Fiona Peel, chair of the NHS Confederation in Wales, welcomed the return of 'strategic intent and development themes', but said the 'agenda set out in the white paper will not be met by further savings in management costs alone'.

Mike Ponton, chair of the Welsh divisional council of the Institute of Health Services Management, 'warmly welcomed' the government's 'focus on the quality of services' and raised 'three cheers for a culture of collaboration in the NHS'. But he said the 'prospectus for major change' would require 'skilled, committed management', especially in primary care. 'Banishing wasteful bureaucracy is essential, but this must not be confused with the fact that better management is fundamental to better health,' he said.

Anne Pegington, secretary to the Royal College of Nursing Welsh board, welcomed white paper pledges to create a new NHS charter for Wales and conduct a survey of patients' experience.

See News Focus, page 17.