ANNEX A:: OUTLINE OF THE EXISTING LAW RELATING TO THE NHS
474.This is a statement of the law relating to the NHS before the enactment of the Health and Social Care (Community Health and Standards) Act 2003.
475.The following paragraphs provide a brief description of the current legislative framework for the NHS. The legislative framework for the NHS in England and Wales is mostly set out in the National Health Service Act 1977 (“the 1977 Act”). This has been amended quite substantially by various enactments, notably by the National Health Service and Community Care Act 1990 (“the 1990 Act”), the Health Authorities Act 1995 (“the 1995 Act”), the National Health Service (Primary Care) Act 1997 (“the Primary Care Act”), the Health Act 1999 (“the Health Act”), the Health and Social Care Act 2001 and the National Health Service Reform and Health Care Professions Act 2002 (“the NHS Reform Act”).
476.Under the 1977 Act, the NHS is essentially split into two different sys­tems. There is first of all 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 midwives or health visitors in clinics or individuals' homes, and the provision of medical services to pupils in state schools. This is the subject of Part I 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 16D of the 1977 Act he has delegated most of his functions to Strategic Health Authorities and Primary Care Trusts (“PCTs”) (a new type of NHS body to both commission and provide NHS care. PCTs enter into arrangements with bodies known as NHS trusts for the provision by the trusts of hospital and community health services.
477.The other main part of the NHS structure is what might be described as “the NHS in the High Street” or “family health services”. This is dealt with under Part 2 of the 1977 Act. The pro­fessionals in ques­tion are general practitioners (“GPs”) (i.e. family doctors), general dental practi­tioners (“GDPs”), oph­thal­mic opti­cians and oph­thal­mic medical practitioners, and chemists.
478.The 1990 Act, the Primary Care Act, the Health Act, the Health and Social Care Act 2001 and the NHS Reform Act introduced a number of changes to these systems of health care. Broadly speaking, the changes introduced by these Acts were as follows -
	The 1990 Act introduced what is known as the internal market; by creating a divide between the planning and purchase of Part I services, on the one hand, and the provision of those services, on the other;
	the Primary Care Act in effect enabled medical and dental services to be delivered, not under Part 2, but under a more flexible system within Part I of the Act, known as ‘PMS’ and ‘PDS’;
	the Health Act made a number of changes, but in particular provided for the abolition of GP fund-holding (introduced by the 1990 Act), the establishment of PCTs and new arrangements to improve the quality of NHS services and co-operation between NHS bodies and local authorities;
	the Health and Social Care Act 2001 also made a number of different changes, but in particular provided for changes to the funding of NHS bodies, local authority scrutiny of NHS provision, changes to the system for filling vacancies for GPs, additional lists for Part II practitioners, the abolition of the NHS tribunal, the provision of “local pharmaceutical services” (similar to the Primary Care Act arrangements for PMS/PDS), and the establishment of “Care Trusts”.
	Part 1 of the NHS Reform Act provided for HAs to be renamed, in England only, as Strategic Health Authorities; for the Secretary of State to be required to establish PCTs for the whole of England and to be able to delegate his functions directly to them; and for many of the service provision functions currently directly conferred on Health Authorities (including those relating to family health services under Part 2 of the 1977 Act) to be conferred on PCTs. In relation to Wales, the Act provides for the establishment and funding of Local Health Boards (“LHBs”) and places a duty on each LHB and local authority in Wales to formulate and implement a health and well-being strategy for the area.