Dan GrimmerPatients have been promised a better service after a radical shake-up in the NHS - but hundreds of health service jobs in the region are under threat.A government white paper published yesterday said GPs would be handed more control over their own budgets - but that will spell the end for primary care trusts such as NHS Norfolk, NHS Great Yarmouth and Waveney and NHS Suffolk, which together employ almost 800 people.Dan Grimmer

Patients have been promised a better service after a radical shake-up in the NHS - but hundreds of health service jobs in the region are under threat.

A government white paper published yesterday said GPs would be handed more control over their own budgets - but that will spell the end for primary care trusts such as NHS Norfolk, NHS Great Yarmouth and Waveney and NHS Suffolk, which together employ almost 800 people.

The primary care trusts currently use the �100m NHS budget to commission services on behalf of the people in the region, but the government announced that from 2013 they will be abolished, with 80pc of the budget in the hands of consortia of GPs.

The government says the GPs know best the services their patients need, so they are better placed to decide how money should be spent.

Patients will also be able to choose which GP practice they register with, regardless of where they live.

But that will signal the abolition of the primary care trusts and strategic health authorities by 2013 as the government looks to cut management costs.

NHS Norfolk, which is based in Norwich, employs around 400 people, NHS Great Yarmouth and Waveney 175 and NHS Suffolk just over 220.

An independent NHS Commissioning Board will oversee the new regime, with local councils taking over the public health element of the PCT's work.

GPs in the region welcomed the move but said it also presents a challenge. Simon Lockett, secretary of the local medical council, said: 'Most Norfolk GPs look forward to the opportunity to do a good job but it's a daunting prospect at a time when the economics are the way they are.

'It could be a poisoned chalice because there are never enough resources to meet the demand. But GPs have been telling the government for years that healthcare is something which has to be rationed and now we will have to put our money where our mouths are.'

NHS Norfolk said it had been aware for some time of the government's intentions to transfer much commissioning to clusters of GPs.

Sheila Childerhouse, the chairman of NHS Norfolk's board, said: 'The Health White Paper is describing a very significant change. We now need to study it in detail and ensure Norfolk's health system is best placed for the years ahead.

'We are fortunate that we have high quality General Practice in Norfolk and we wish to continue working with all clinicians, including GPs, now and going forward.

'We shall also be talking to our staff about the roles that they will be able to play in the future.'

Dr Ian Mack, a GP in Watlington and chairman of NHS Norfolk's clinical executive, said: 'It is to be welcomed that front line clinical staff will play a much greater role in shaping local services for patients and achieving value for money.

'NHS Norfolk already works with GPs, clustered in practice-based commissioning consortia across the county.

'However the scale of the proposals is much greater and it is to be welcomed that the new GP consortia will control the majority of local healthcare spending.

'With such power also comes responsibility to make the best use of NHS resoruces.

'It seems clear that there will be a significant re-organisation which we as a primary care trust will lead and help shape.

'To that end we have already invited all of Norfolk's 540-plus GPs to a forward planning event in the autumn to ensure the transition works in the best interests of patients.'

David Edwards, chairman of NHS Great Yarmouth and Waveney, said: 'We welcome any service change that puts the patient at its heart.

'We already have very close working relationships with our GPs across the Great Yarmouth and Waveney area.

'We are working together with our staff to give the paper the proper consultation now that it has been published.'

The white paper warned that NHS job losses were 'inevitable' but said it was vital to switch cash from bureaucracy into frontline services.

The document stated: 'Inevitably, as a result of the record debt, the NHS will employ fewer staff at the end of this Parliament.'

Health secretary Andrew Lansley said: 'The government's ambition is for health outcomes - and quality services - that are among the best in the world.

'We have in our sights a unique combination of equity and excellence.

'With patients empowered to share in decisions about their care, with professionals free to tailor services around their patients and with a relentless focus on continuously improving results, I am confident that together we can deliver the efficiency and the improvement in quality that is required to make the NHS a truly world class service.'

But shadow health secretary Andy Burnham said 10 years of 'painstaking work' to raise standards in the NHS had been 'thrown in the air' and dubbed it a 'huge gamble'.

Think tank the Social Market Foundation also criticised the plans, comparing giving control of NHS funds to GPs to 'asking your waiter to manage a restaurant.'

Health pressure group the NHS Support Federation accused the government of favouring commercial business over patients, arguing GPs would need to turn to the private sector to manage budgets.

Paul Evans, federation director, said: 'Patient power will be overwhelmed by the influence of unaccountable companies.

'No matter what individual patients want, profit-motivated firms will now have a huge say in what care is available and much of the fairness, value and public trust in the traditional NHS will be lost.'