ANNEX A: OUTLINE OF THE EXISTING LAW Existing legislation about the NHS National Health Service Act 1977
340.Under the 1977 Act, the NHS is essentially split into two different systems. The first is the system which consists primarily in the provision of health care in hospitals. It also covers those services described as “community health services”, for example the services provided by district nurses, midwives or health visitors in clinics or individuals’ homes, and the provision of medical services to pupils in state schools. This system is the subject of Part 1 of the 1977 Act. The responsibility for securing the provision of these services to patients rests with the Secretary of State, although under his powers in section 16C (formerly section 13) of the 1977 Act he has delegated most of his functions to Health Authorities. Health Authorities enter into arrangements with bodies known as NHS trusts for the provision by the Trusts of hospital and community health services.
341.The other main part of the NHS structure is what might be described as “the NHS on the high street”. This is dealt with under Part 2 of the 1977 Act which governs the arrangements made by Health Authorities for the provision of services by the following professionals:general medical practitioners (GPs) (i.e. family doctors), general dental practitioners (GDPs), ophthalmic opticians and ophthalmic medical practitioners (also known as optometrists), and pharmacists . They respectively provide what are termed general medical services (GMS)(section 29ff), general dental services (GDS)(section 35ff), general ophthalmic services (GOS)(sections 38-40) and pharmaceutical services (PhS)(sections 41-43) respectively. The remainder of Part 2 contains other provisions relevant to the provision of these “high street” services, which are often referred to as family health services.
342.The 1990 Act, the Primary Care Act and the Health Act introduced a number of changes to these systems of health care. Broadly speaking, these changes were as follows:
343.The two systems, Part 1 and Part 2, are very different. It should be noted that despite the changes introduced by the Primary Care Act the provision of Part I services is distinct from the provision of services under Part 2. The changes proposed in this Act will not alter this divide. The following is a more detailed description of the two systems.