The NHS is bracing itself for what could be the biggest shake-up in 60 years. Primary care trusts are to be disbanded as the new government promises to put patient care 'back into the hands of family doctors'. Reporter DAN COOMBS met NHS Hillingdon chief executive Yi Mien Koh to find out what the White Paper could mean for healthcare in the borough

THE White Paper would represent a 'seismic transformation' of the National Health Service, according to Professor Yi Mien Koh. When she joined Hillingdon PCT - now known as NHS Hillingdon - five years ago, the organisation was beset by financial troubles. Fifty million pounds in the red, it was among the worst debtor primary care trusts in the country.

Five years on, and the health provider is free of debt and, it insists, better placed than any to deal with the changes laid out by the new government.

"The changes proposed are enormous, and nobody could have predicted they would happen on such a rapid scale," said Professor Koh.

NHS Hillingdon is to be entirely disbanded by April 2013. Instead of the 'top-down' approach of NHS management, healthcare provision will be run and organised by local GPs in a 'bottom-up' approach.

'GP consortia' will decide the direction for healthcare in their area, and be held accountable by a newly created HealthWatch panel of patients, meaning the independent Hillingdon LINk health watchdog, will also likely to be disbanded.

As with any reorganisation, particularly in straitened times where cost-cutting is vital, staff fear for their jobs. Professor Koh has reassuring words.

"We have been effectively living in recession for the past five years; we know how to be thrifty, to get more for less," she said.

"As we have been saving so efficiently, I do not think there will be significant redundancies. Our staff are very good at their jobs and have expertise which will be of benefit. Ultimately it will be down to the GPs whether they wish to utilise that expertise."

Once a doctor herself, the professor keeps a finger on the pulse of the front-line troops. "I speak regularly with GPs across the borough, and have spoken to many in the past week since the White Paper was announced," she said.

"A significant number of them are very keen for this change."

GP consortia will begin shadowing NHS Hillingdon in preparation for the seismic shift of 2013, and NHS communication teams will keep the public informed of the changes.

There are expected to be only two or three GP consortia in the borough, with final numbers based on population figures.

All GPs are members of the Practice Based Commissioning Group, which will act as a framework for the GP consortia.

There are three in the borough, one in each parliamentary constituency.

GPs will therefore make big decisions, by commissioning projects and pinpointing the best care for patients.


SOMETHING which will not be happening is big spending projects on health centres - there is no money in the pot.

"There isn't the capital to go making grand decisions on building centres," said Professor Koh. "We should be looking at what we have, and getting the best out of the facilities."

So does this mean an end for the polyclinic programme?

Earlier this year, one was proposed for each borough constituency by NHS London.

Professor Koh believes they could now be dead in the water, although she is keen not to confuse the medium with the message.

"'Polyclinics' was never how we referred to them," she said.

"It was an NHS London brand given to a large community health centre, aimed at improving access and relieving hospitals of pressure.

"This is an area we will be looking at. "What we want is better management and long term co-ordination across different areas, working as a network."


ONE thing is certain: More integration between healthcare providers and Hillingdon Council.

Being able to link with adult and social care provision, a council responsibility, will be of benefit, said Professor Koh.

HealthWatch, the patients' forum, will be set up and funded by the local authority and health service staff could be integrated into the council structure.

Professor Koh said: "We have anticipated there would be more of a link between ourselves and the local authority.

"This is why we joined together to employ Dr Ellis Friedman as director of public health earlier this year, with both of us (NHS Hillingdon and Hillingdon Council) paying 50 per cent of his annual salary."

The bodies have come up with a plan to build Yiewsley Health Centre, at the site of the swimming pool, with the council buying the building and leasing it to NHS Hillingdon.


* The Department of Health describes the White Paper as 'liberating the NHS' * It aims to cut down on 'top-down' bureaucracy by removing

targets and paperwork and reducing management costs by 45 per cent * GPs will commission NHS services * Patients will be allowed to choose their GP practice * Patients will have access to their health records * The Care Quality Commission will remain to monitor standards * £20billion savings by 2014 * PCTs abolished in April 2013 * Patient group

HealthWatch will hold GP consortia accountable, as will Department of Health