History of NHS Alliance

The origins of NHS Alliance lie in the spontaneous development of Locality Commissioning Groups throughout the United Kingdom during the early 1990's. A number of those involved in these early Locality Commissioning Groups met for the first time in Telford in March 1994. They found that they held a number of beliefs in common. It is these that now underpin the philosophy of NHS Alliance though they ran counter to the Government policy of the time.

First and foremost, perhaps, was the belief in equity and fairness within the NHS. Also a related belief that issues of health and the planning and provision of health services should focus on the whole local population and the professionals providing them. The internal market, they felt, was creating division and vested interests and that patients would be better served by a system committed to co-operative working and mutually agreed solutions. Indeed the early Locality Commissioning Groups were co-operatives of local practices, which looked after the whole of their local population and worked with the local Health Authority and local Trusts to improve local health services. Although this philosophy ran counter to some of the principles behind fundholding, fundholders were as keen to embrace this inclusive culture as non-fundholders. Particularly as these groups gave them some say over the 70% or so of secondary services, which were not covered by fundholding as well as opportunities for input into planning health services and health itself.

That meeting of 40 or so GPs and managers in Telford led to the establishment of the National Association of Commissioning GPs (NACGP). This became the national representative body for the rapid development of Locality Commissioning Groups, which by 1997 numbered 175 covering 12 million patients. In some ways it was a remarkable achievement given that this was an entirely independent movement neither supported financially nor in principle by the Government at the time. Yet by the time of the general election in May 1997, 75% of GPs were in favour of Locality Commissioning as a model for primary care of the future. Indeed the development of the then Government model - fundholding - with the creation of Total Purchasing Pilots and Multifunds was also to beginning to look like Locality Commissioning.

Towards the end of the summer of 1997, the national executive of the National Association of Commissioning GPs were commissioned by the new Minister of Health, Alan Milburn, to write a document, which was entitled "Restoring the Vision". That document can be viewed on this website. A few months later the White Paper that heralded the New NHS - "The New NHS - modern and dependable" was published. Many of the themes of "Restoring the Vision" can be found in the subsequent White Paper. The National Association of Commissioning GPs campaigned for the establishment of Locality Commissioning Pilots and in April 1998, the present Government launched 40 countrywide Locality Commissioning Pilots. These represented the first time that Locality Commissioning had ever been nationally recognised, supported and centrally financed. These Pilots were seen as the prototypes for Primary Care Groups, which were launched a year later on 1st April 1999. Many lessons were learnt, which are now proving valuable in the development of Primary Care Groups and these have been written up by HSMC Birmingham.

"Restoring the Vision" suggested that there should be local groups responsible for the health and care of their local population, which would be able to take on various levels of budgetary responsibility. The groups themselves were foreseen as multi-professional The case for GP commissioning developing into "primary care commissioning" was also made in two books on commissioning by members of the NACGP national executive.

The development of "Primary Care Groups" involving all professionals in primary care saw this prophecy fulfilled. At the same time, the word "commissioning" which NACGP had used to describe health and healthcare planning, purchasing, provision and evaluation had become restricted in Government guidance to the purchasing of secondary care. The concept of a national body, which was restricted to GPs and used the word "commissioning" given its new sense was no longer viable. It was time to widen the remit of an organisation that consisted largely of GPs (approximately half fundholders and half non-fundholders) and managers but which had had little input from nurses, social services or lay people.

For these reasons, NHS Alliance was launched in May 1998 as a future representative organisation of Primary Care Groups and other primary care organisations. Its purposes and aims were refined following feedback from around 100 Primary Care Groups during the summer of 1999 and they remain the same today.

Today, all of the Primary Care Groups have become Primary Care Trusts. Their prime role is in developing primary care, commissioning services and improving local health. NHS Alliance has been closely involved in their establishment and is now closely involved in their ongoing development. Today NHS Alliance represents well over 90% of Primary Care Trusts in England and a significant number of primary care organisations in Wales, Scotland and Northern Ireland. It also holds close partnerships with a wide variety of organisations including NHS Confederation, The Institute of Health Managers, The Royal College of General Practitioners, The Royal College of Physicians, The Small Practices Association, The National Association of Non Principals, The Royal College of Nursing, The Community Practitioners and Health Visitors Association, The Long Term Medical Conditions Alliance, Doctor Patient Partnership, British Dental Association and the Primary Care Pharmacists Association to name but a few.

We have gone a long way since those forty rebels met in Telford. The secret of today's modern NHS Alliance is, perhaps, that of being a value-based organisation. An organisation that fully supports the fundamental values of the NHS and one that is an inclusive organisation, deeply rooted in primary care but which has clear philosophies and aims that it has held since its earliest days.