³ÉÈË¿ìÊÖ

It may be only 39 pages long, but the so-called Five Year Forward View for the NHS in England packs more of a punch than many weightier tomes written in the corridors of power.

Simon Stevens, the new chief executive of NHS England, has kept a low profile in his first six months in the job. He clearly wanted to craft a concise vision for the NHS which would make people sit up and take notice.

He is signalling a big shift in the way the NHS in England is managed and organised, in some ways the most radical since the service was born in 1948.

Mr Stevens and his colleagues want to see barriers being removed and an end to the age-old divide between GPs with patients, and consultants with hospitals.

There should, in his view, be no more top-down reorganisations, but instead the development of new models to suit local needs.

He believes some communities will want to expand the role of GP practices allowing them to provide a much wider range of care.

These practices might employ consultants and senior nurses with the aim of shifting most outpatient work away from hospitals.

Alternatively leading hospitals might open their own GP surgeries. Smaller hospitals could be preserved if taken under the wing of larger institutions.

The most radical option flagged up in the document is the development of "Accountable Care Organisations" similar to those in Spain and parts of the United States.

Translated from the jargon, this means a single organisation taking responsibility for all of a local population's health needs.

This could be a major hospital trust doing everything in its area, employing GPs and community health staff as well as acute care.

This is big picture stuff and the sceptics will argue that it will take several years to develop these new models of care.

Hard-pressed GPs might feel immediate help is needed to reduce the pressure on their practices. The difference between no more government reorganisations of the NHS but allowing local communities to reinvent health care may not be easy to explain.

For Westminster and the political parties, there is one key message - you have to find more money.

Blanket demands for cash at a time of government austerity were never going to cut much ice.

But Mr Stevens, with the support of the health regulator Monitor, has done some careful financial modelling.

They say the NHS could stretch to the most ambitious efficiency savings in its history.

Even after that though, increases above inflation are needed. Presented in a technocratic, non-political style and with the support of other NHS organisations, this call for more funding carries weight.

So now it's over to NHS staff and managers, patients and the politicians.

Mr Stevens and his colleagues have explained how they think the NHS can be made to work in the face of mounting pressures.

But they believe they can only facilitate and encourage rather than order change from on high.