Health and Care bill 2021
The Government published the integration and innovation white paper in February 2021. It proposed reforms to be included in a Health & Care Bill, (the bill) to restructure parts of the NHS in England and create a 'truly integrated' healthcare system with less bureaucracy. Following this, MPs on the Health Select Committee held an inquiry to gather feedback on the Government's proposals. The RCGP submitted a written response to the inquiry (PDF file, 495 KB), which was later supported and referenced in the committee's report to government.
The Bill was published and first introduced in the House of Commons on 6 July 2021, with the reforms set to effect as early as April 2022. Former Chair of the RCGP Martin Marshall responded to the Bill’s first reading, and we will be closely monitoring its progression through Parliament over the next few months.
What changes are included in the Bill?
Amongst several significant changes, the Bill places integrated care systems (ICSs) on a statutory footing, making them accountable for commissioning and delivering services to the patients in their footprint. The Bill also includes a new duty on NHS England and local authorities to collaborate on the delivery of care and provide the Health Secretary with increased powers to intervene in the reconfiguration of services.
Further information on the Bill, and the RCGP's work to influence it, can be found below.
ICS stands for Integrated Care System. There are 42 ICSs in England, comprised of GP surgeries, community and mental health trusts, hospitals and other primary care services, with local authorities and other care providers. The providers, commissioners and local partners in an ICS are responsible for planning and delivering healthcare services to patients in their area.
The Health and Care Bill proposes establishing ICSs as statutory bodies in all parts of England.
Timeline and key links
- Members of the House of Lords voted in favour of Amendment 80 to the Health and Care Bill, which calls for stronger workforce planning for the NHS. The RCGP and over 100 other organisations are in support of this amendment. We must now convince MPs to do the same, as the Bill will return to the House of Commons to vote on any changes made to the Bill in the Lords.
- Ahead of the report stage in the House of Lords, we briefed (PDF file, 327 KB) peers on our key priorities for the Health and Care Bill, including a stronger primary care voice, better workforce planning and addressing health inequalities. This is another opportunity for peers to table, debate, and vote on proposed changes to the legislation before it heads back to the House of Commons for approval.
- We briefed peers ahead of the committee stage in the House of Lords. This is the first opportunity for members of the House of Lords to table and debate amendments to the Health and Care Bill. Our brief (PDF file, 312 KB) outlines an amendment to the Bill on the need for stronger primary care representation in future healthcare systems. The RCGP put forward this amendment with the support of the Royal Pharmaceutical Society (RPS) and the Association of Optometrists (AOP). During the committee stage, former Chief Executive of the NHS Lord Nigel Crisp tabled the amendment and was supported by several members from across the House.
- We briefed peers on our key priorities for the Health and Care Bill (PDF file, 328 KB). Ahead of its Second Reading in the House of Lords, which is the first opportunity for peers to debate the main principles and key themes of the Bill.
- Alongside a range of over 60 organisations, the RCGP supported an amendment to the Health and Care Bill, which called for stronger workforce planning. It was tabled by former health secretary Jeremy Hunt MP and voted on by MPs during the report stage in the House of Commons. Though the amendment had the support of 36 cross-party MPs, including former Shadow Secretary of State for Health and Social Care Jonathan Ashworth MP and six select committee chairs, it was unfortunately voted down (219 ayes, 280 no’s). Find out more about the amendment.
- We hosted a virtual roundtable with leading organisations representing a wide range of professions in Primary Care. GPs, nurses, pharmacists, optometrists, and dentists. The Chair of our Primary Care Patient Group discussed concerns and priorities for Integrated Care Systems (ICSs) as the Health and Care Bill progresses through Parliament.
- We submitted a written response (PDF file, 305 KB) to the House of Commons Public Bill Committee for the Health and Care Bill call for evidence outlining our position on the Bill.
- RCGP Former Chair Professor Martin Marshall represented GPs in an oral evidence session with MPs and Ministers on the House of Commons Public Bill Committee for the Health and Care Bill. Watch the full session or look at a summary of key points raised.
- RCGP Live event on 'The Health & Care Bill: what does it mean for GPs and patients?'
- Former Chair of the RCGP Professor Martin Marshall responded to the First Reading of the Health and Care Bill.
- We briefed MPs on our key priorities for the Health and Care Bill (PDF file, 348 KB), ahead of its Second Reading, which is the first opportunity for MPs to debate the main principles and themes of a Bill.
- We hosted a roundtable for members on ICSs (PDF file, 469 KB) and the practical action that can be taken to cultivate a strong primary care voice in all systems.
- We responded to the Health and Social Care Select Committee inquiry (PDF file, 495 KB) on the Department for Health and Social Care's white paper 'Integration and Innovation: working together to improve health and social care for all'.
- GP Online published an article: "General practice must be 'foundation of any successful ICS', warns RCGP"
- The government set out proposals for a Health & Care Bill.
- MPs on the Health and Social Care Select Committee launched an inquiry on the white paper.
- We responded to the NHS England and Improvement consultation (PDF file, 488 KB) on the ‘Next steps to building strong and effective integrated care systems across England.
If you have any questions, concerns or insights about the proposed reforms, email us at firstname.lastname@example.org.
The Health and Social Care Act
The Health and Social Care Act received Royal Assent in March 2012. It has enormous implications for patient care in England, placing into law the most extensive restructuring of the NHS in its history.
The implementation of the Act is ongoing, with new Clinical Commissioning Groups (CCGs) taking on full responsibilities on 1 April 2013.
This section contains a record of the College’s response to the Act when passed through Parliament, as well as input the College has had on the passage of subsequent regulations that enforce the Act.
Section 75 Regulations
On 28 February 2013, the RCGP wrote to Ministers expressing our concerns that regulations laid before Parliament relating to Section 75 of the Health and Social Care Act would severely restrict CCGs’ freedom to decide not to expose services to market competition.
In response to concerns raised by RCGP and others, the Government revised and relaid these regulations before Parliament on 11 March. The RCGP believes that whilst the new version of the regulations is a step in the right direction, they need to go further to clarify that CCGs will have the autonomy to decide not to put services out to competition.
On 14 March 2013 the RCGP wrote to the House of Lords Secondary Legislation Scrutiny Committee expressing our view that Clause 5 should be removed from the new version of the regulations.
On 23 April RCGP briefed members of the House of Lords ahead a motion to annul the new version of the regulations. RCGP called for the regulations to be withdrawn so that the wording of some sections (particularly Clause 5) could be clarified.
On 24 April, Peers voted not to annul the regulations. RCGP will be engaging with the regulator and monitor to ensure that assurances from the Government that CCGs will be free to choose not to put services out to competition where they feel this is in the best interests of patient care are reflected in the guidance which will be used to interpret the regulations.
RCGP activity during the Act’s passage through Parliament
- March 2012 – Royal Assent.
- February 2012 – Read the RCGP’s Competition Briefing (PDF file, 38 KB) (prepared after the House of Lords Report stage)
- February 2012 – the RCGP wrote to the Prime Minister calling for the wholesale withdrawal of the Health and Social Care Bill. The decision was made following careful consideration of the amendments to the Bill published by the Government on 1 February 2012, and subsequent responses that were received from Ministers following requests for clarification on our concerns.
- February 2012 – House of Lords Report Stage: Read the RCGP’s Briefing (PDF file, 52 KB)
- October 2011 – House of Lords Second Reading: Read the RCGP’s Briefing (PDF file, 52 KB)
- June 2011 – Changes to the Health and Social Care Bill announced based on recommendations made by the NHS Future Forum. Read the RCGP's written evidence to the Public Bill Committee on the re-committed Bill (PDF file, 106 KB)
- June 2011 – Read a transcript of the Public Bill Committee oral evidence session on 28 June 2011 (witnesses included Dr Clare Gerada, RCGP Chair of Council) [Parliament website]
- May 2011 – RCGP issued an analysis paper on the Health and Social Care Bill which highlights concerns in specific areas. Read the RCGP analysis of the need for clarification and change (PDF file, 182 KB)
- May 2011 – The RCGP sent a letter to Prime Minister David Cameron with a copy of the analysis paper – Read the letter to Prime Minister David Cameron (PDF file, 37 KB)
- May 2011 – RCGP submitted a formal response to the Government's NHS Listening Exercise. Read the RCGP Response to the Listening Exercise (PDF file, 246 KB)
- February 2011 – RCGP Chair Dr Clare Gerada gave oral evidence to the Health and Social Care Bill Committee. Read a transcript of the evidence session [Parliament website]