ANNEX A: Outline of the existing law relating to the NHS(12)
195.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 1977 Act. This has been amended quite substantially by various enactments, notably by the 1990 Act, the Health Authorities Act 1995 (the 1995 Act), the Primary Care Act, the Health Act and the HSC Act.
196.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 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 16D (formerly section 13) of the 1977 Act he has delegated most of his functions to HAs.  HAs enter into arrangements with bodies known as NHS trusts for the provision by the trusts of hospital and community health services.
197.The other main part of the NHS structure is what might be described as “the NHS in the High Street”.  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.  They respectively provide what are termed GMS (see section 29ff), GDS (see section 35ff), general ophthalmic services (see section 38-40) (GOS) and pharmaceutical services (see sections 41-43).  The remainder of Part 2 contains other provisions relevant to the provision of these High Street services, which are sometimes referred to as “family health services”.
198.The 1990 Act, the Primary Care Act, the Health Act and the HSC Act introduced a number of changes to these systems of health care although not all of those in the HSC Act are yet in force. Broadly speaking, these changes were as follows:
199.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 1 services is distinct from the provision of services under Part 2.  The changes proposed in this Act will not alter this divide.
200.What follows is a more detailed description of the two systems.