Tony Blair described the white paper as fitting the NHS around the needs of the patient, not fitting the patient around the NHS. The plan is to make it easier for people to choose a GP practice that offers access convenient for their daily lives - and that may include early morning, late evening or Saturday appointments.
Primary care trusts will be able to bring in new providers, offering more convenient opening hours, perhaps in supermarkets. Companies providing the out-of-hours service would be allowed to take booked appointments.
Patients could register near their place of work instead of near home, but could not have dual registration, which would be costly and might undermine continuity of care.
Local people dissatisfied with the service will have the right to petition the primary care trust to organise a better one. GPs running single-handed practices will be allowed to continue, but they will be encouraged to band together to offer the full range of services.
MoTs
The white paper was informed by patients' juries, culminating in a "citizens' summit" in Birmingham. The favourite reform was "a regular health check or MoT for everyone" - proposed by health secretary Patricia Hewitt and backed by 76% of participants. But the idea would have created a huge extra workload for GPs without evidence of a commensurate health gain. Instead the white paper proposed an online questionnaire to help people assess their personal health risks, given family history and lifestyle. Pilot schemes will be available to new parents and people in their 50s from 2007. Those at risk will be able to ask for lifestyle advice from a new band of "health trainers." Ms Hewitt employed the phrase "health MoT" to describe the online self-assessments. Other new services will include "wellbeing prescriptions", encouraging GPs to prescribe exercise and activities.
Health promotion
The white paper gives a chilling warning of the perils of obesity, smoking and drinking. It said: "As a nation, we are faced with the real possibility that - due to lifestyle changes - our children will not live as long as their parents unless there is a shift towards healthier living."
Spending on public health programmes to prevent illness was less than 2% of the NHS budget, less than half the proportion in the US, Germany and the Netherlands. It will increase, but a target has not yet been set. A high-profile campaign will be developed in the runup to the Olympic games in London in 2012 to "encourage everyone to contribute to the drive for a fitter Britain".
Social care
There will be more support for carers, including a national helpline and improved emergency respite arrangements. People needing care will be assigned "individual budgets", allowing them to choose the services they need without necessarily having to handle the cash to pay for them.
Psychological therapy for people of working age with moderate mental health problems will be tested at two demonstration sites. There will be rapid response services for people coming towards the end of life, to be known as the "hospice at home" scheme.
