News

GPs firm on fundholding

Britain’s general practitioners believe in the expansion of primary care and health promotion by the NHS, but want to shed the burden of responsibility for 24 hour care, and continue to reject the government’s GP fundholding experiment, according to a national survey.

Seventy percent of the country’s GPs responded to a detailed questionnaire, Your choices for the future, sponsored by the General Medical Services Committee. The results of the survey surprised even the Medical Practitioners Union (MPU), which has been arguing for the radical reform of general practice for many years.

The survey revealed that almost three-quarters of all GPs would like to opt-out of the out-of-hours responsibility for providing medical services at night and weekends. A majority would be willing to participate in some form of duty rota, with 84 percent supporting the establishment of local primary care emergency centres.

Fifty five percent of doctors supported the MPU policy that GPs should have the option to become salaried, instead of remaining independent contractors to the health service as at present. Over one in ten believed that all GPs should be salaried employees of the NHS. On a personal level, over half either wished to or would consider a salaried post, with almost two-thirds of women being in favour compared to just under half of men.

The survey clearly demonstrated the state of disillusionment in the profession. GPs think that too much is being demanded of them, and that their services are being under-valued. There was widespread support for a reduction in patient list sizes, but also for the expansion of the primary health care team to provide virtually all types of validated health services within a community setting.

Doctors continue to oppose key elements of the government’s policies for primary care. While 50 percent believed there should be more emphasis on health promotion by the NHS, only 11 percent believed that the government’s approach was a cost-effective one. There are early signs that the government itself may agree with this assessment, and move to abolish the three-yearly health checks introduced as a part of the GP contract in 1990.

Fundholding also remains very unpopular, with less than 20 percent supporting the concept, though there is some evidence of weakening of the opposition. The finding that only one third of GPs expecting to become fundholders in the ‘third wave’ support the fundholding principle adds weight to the argument that doctors feel obliged to jump on the bandwagon for fear of being ‘left behind’.

Overall, Your choices for the future provides considerable evidence that the majority of GPs have a vision of the future of primary care which is in stark contrast to that being pursued by the government.