Chapter 2 - NHS bodies roles and functions

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A brief description of the role of the different public bodies within the NHS.

 

1.          The NHS is composed of a large number of public bodies, all of which have different functions and on occasions overlapping responsibilities.  It is necessary to have some understanding of the roles and responsibilities of the different bodies in order to understand where general practice fits into structures of the NHS.

 

2.          NHS bodies can broadly be divided into 3 types, namely:

a.          Commissioners of NHS services;

b.          Providers of NHS services; and

c.           Regulators, namely public bodies which supervise the performance of those individuals and public bodies who commission or provide NHS services and body that oversee the performance of NHS bodies.

 

3.          Some NHS bodies perform more than one function.  Hence, for example, NHS England is both a commissioner and a regulator.  The Secretary of State sits at the apex of the NHS.  The Secretary of State is a cabinet minister and a member of parliament, usually an elected MP.  The present occupant of the office is Rt. Hon Jeremy Hunt MP.  The Secretary of State has overall political responsibility for the NHS and plays a key strategic role, particularly by setting the Annual Mandate for NHS England.  However his operational legal role has been substantially diminished by the Health and Social Care Act 2012.

 

Commissioners of NHS services

4.          The main commissioners in the NHS are:

 

         a)               NHS England:  NHS England is the “trading name” of the National Health Service Commissioning Board.  This body was created by the Health and Social Care Act 2012.  It licences and, to an extent, manages, Clinical Commissioning Groups.  However NHS England is also a commissioner of a wide range of specialist NHS services, including prison health services, medical services for the armed forces and a wide range of specialised and tertiary acute services.  NHS England commissions services for patients with rare conditions and also commissions primary care medical and dental services.  This means that all GP practice contracts are between NHS England and the local GP provider.  Detailed arrangements for NHS England are set out in Schedule 1 to the Health and Social Care Act 2012;

 

         b)               Clinical Commissioning Groups:  These are local corporate public bodies created by the Health and Social Care Act 2012.  The members of a CCG are the local general practices in the CCG area who hold NHS commissioning contracts with NHS England.  CCGs substantially replaced primary care trusts by taking on the commissioning of a range of acute and community NHS services (other than primary care, dental care and specialist services) for the patients for which the CCG has responsibility.  The CCG has a constitution and a Board, which is partly elected by the local GPs, and partly consists of other stakeholders in the local NHS.  Detailed arrangements for CCGs are set out in Schedule 2 to the Health and Social Care Act 2012; and

 

          c)               Local Social Services Authorities:  The Health and Social Care Act 2012 transferred responsibility for public health commissioning from primary care trusts to the local authorities.  In practice this means that commissioning public health services is the responsibility of unitary local authorities or, in a case where there are 2 tiers of local authority, the county council.

 

Providers of NHS services.

5.          The main providers of NHS services are:

 

a.          GP practices:  Almost all GP practices are private sector businesses which are owned by GPs which contract with NHS England to provide primary care services to NHS patients across one or more practice areas.  A GP practice can be owned by a single GP, a partnership of GPs, a partnership consisting of GPs and other approved persons or by a medical company.  More details of the types of organisations that can hold GP contracts can be found here;

 

b.          Dental practices:  Almost all NHS Dental practices are private sector businesses which are owned by dentists which contract with NHS England to provide primary care services to NHS patients across one or more practice areas.  Largely same restrictions on ownership apply to dentists as apply to GP practices;

 

c.           NHS Trusts:  These are NHS bodies created under Chapter 3 of Part 2 of the NHS Act 2006.  NHS Trusts enter into acute services contracts with CCGs to provide a wide range of community, mental health and hospital services to patients.  The present plan of the government is that all NHS Trusts should become NHS Foundation Trusts or be taken over by an NHS Foundation Trust by 2016.  The Secretary of State has the power to issue Directions to an NHS Trust under section 8 of the NHS Act which, if lawfully made, imposes specific legal obligations on NHS Trusts to do things or provide services, or to cease to do something or cease to provide a service as specified in the Direction;

 

         d)               NHS Foundation Trusts:  These are public benefit corporations under Chapter 5 of Part 2 of the NHS Act 2006.  NHS Foundation Trusts have Members and Governors, as well as a Board of Directors.  NHS Foundation Trusts are accountable to a regulator, known as Monitor and are accountable to their members.  The Secretary of State has no power to issue Directions to an NHS Foundation Trust;

 

         e)               Special Health Authorities: These are NHS bodies that perform particular specialist functions within the NHS such as NHS Blood and Transplant which co-ordinates the supply of blood and organ transplantation services for the NHS;

 

Regulators of NHS services.

6.          The main bodies that regulate the performance of services by NHS bodies and have an interest in the way that NHS bodies are managed are as follows:

 

         a)               The Care Quality Commission:  The CQC is the statutory body with responsibility for ensuring that hospitals, care homes, dental and GP surgeries, and all other care services in England provide people with safe, effective, compassionate and high-quality care, and to encourage them to make improvements.  The CQC inspects and reports on all providers of social and health care in England, covering both the state and private sectors;

 

         b)               Monitor:  Monitor was previously known as the Independent Regulator for NHS Foundation Trusts.  However its role was changed by Part 3 of the Health and Social Care Act 2012. Its new role is to “protect and promote the interests of patients” by attempting to ensure that the whole health sector works for their benefit.  It is, in effect, the competition regulator for the health market and so now has interests which extend far beyond NHS Foundation Trusts.  It exercises a range of powers granted by Parliament which include setting and enforcing a framework of rules for providers and commissioners, implemented in part through licences issued to NHS-funded providers;

 

          c)               NHS England:  NHS England has a regulatory function in respect of CCGs.  It licences CCGs and can step in if a CCG is not performing properly;

 

         d)               Healthwatch: Healthwatch is the latest in a long line of public bodies which are designed to feed the voice of the patient into the NHS.  Previous bodies include Community Health Councils and PALS.  Healthwatch England is a new public body set up by the 2012 Act to act as a national champion of patients’ interests.  There are now 152 local healthwatch groups who are supposed to champion the interests of patients in their local NHS.  It is too early to tell whether local healthwatch groups are likely to have any real impact on local service delivery.

 

         e)               Health Overview and Scrutiny Committees:  These are committees made up of members of the local social services authority.  Their role is to “review and scrutinise any matter relating to the planning, provision and operation of the health service(5) in its area:  see Part 4 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.  The committee must be consulted about any “substantial development of the health service in the area of a local authority” and, if they consider that the development is not “in the interests of the health service in its area”, it can refer the decision to the Secretary of State who then becomes the final decision maker;

 

          f)               Health and Wellbeing Boards:  The Health and Social Care Act 2012 establishes health and wellbeing boards as committee of the local authority.  It should be a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities, in particular by facilitating better working between health and social care services.  Health and wellbeing board members ought to collaborate to understand their local community's needs, agree priorities and encourage commissioners to work in a more joined-up way. As a result, patients and the public should experience more joined-up services from the NHS and local councils in the future.


David Lock QC

David Lock QC is a barrister at the Landmark Chambers.

180 Fleet Street
London, EC4A 2HG
DX 1042 (London)

He was called to the Bar in 1985 and was appointed Queens Counsel in 2011.

David Lock QC is Head of the Administrative & Public Law Group and the Judicial Review & high Court Challenges Group at No5 Chambers. - See more at: http://www.no5.com/barristers/barrister-details/137-david-lock-qc/#sthash.PcnGl1Eh.dpuf

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