News

Some patients are more equal…

GP fund holding is approaching the end of its first year. The scheme has been hailed as a success by fundholders themselves, the government, and now by the recent report by Professor Howard Glennester, published by the King’s Fund - although this report examines only the first 3 months experience of 10 of the 306 GPs involved.

Critics argue that the scheme has been successful only in its own terms, and that it has been expensive, fragmentary, inequitable and unnaccountable. Being the preserve of large practices in affluent areas, it has widened inequality in health care access and hastened the trend towards a two tier service.

Patients of budget holders have been getting faster treatment from cash-starved hospitals, while consultants from the hospitals have been enticed to see patients in the GP’s surgery. Bluntly, the 7% of the population covered by the fundholding practices get preferential treatment.

The 306 first wave practices have cost the NHS £14.5m in practice management fees alone. The extra bureaucracy from practice level through regions to the Department of Health has been enormous.

While district health authorities are assessing local health needs and directing resources to meet them, fundholders have no such planning ability. They receive cash direct from the regional health authority which has been deducted from the district’s budget - leaving it less able to meet the needs it has identified.

GP fundholding has legalised a two tier service and heralds the fragmentation of primary care. The GP is pushed from being the advocate of the patient to the guardian of the practice budget. The market place becomes inextricably entwined with the consulting room, creating a new breed of entrepreneurial GP.

Any advantages of the fundholding scheme could have been achieved without the scheme’s invention, which has been an expensive mistake which threatens the egalitarian and caring ethos the NHS has embodied since its beginnings.