NHS reforms embed

Tracing Our Roots

Where we are today in private healthcare owes much to events in the NHS. Dr Ellen Welch continues her series with the key milestones from the 1990s.

 1990 NHS reorganisation – The National Health Service Community Care Act receives Royal assent, pushing through the proposals of the 1989 Working for Patients paper to split the provision and purchasing – or commissioning – of healthcare. 

The act allows the Health Secretary to establish NHS trusts by order. These assumed responsibility for the ownership and management of hospitals previously managed by the regional or district health authorities.

 New GP contracts see greater external management of general practice and established financial incentives for GPs to become more involved in health promotion. GPs get paid for collating information such as the height, weight and blood pressure of patients. 

The next year, GP fundholding allows some GPs to take on responsibilities for commissioning services for patients, becoming more involved with the wider health system. This brings criticism that a two-tier system has been created, in which patients in practices with GP fundholders are able to access care more rapidly.

 NHS Confederation is founded out of the National Association of Health Authorities and Trusts. It claims to represent the whole NHS.