News

Government slows down race towards budget holding

The Department of Health (DoH) seems to be accepting the move towards budget holding should be slowed down and that there should be a balance between budger holders and non-budget holders in all areas.

For the DoH budget holding has its good and bad points. Its promotion keeps the pace of the NHS changes steady and ministers happy. But..

• Accountability is a problem. Are budget holders meeting need or merely reacting to demand? Is the scheme value for money in terms of the overall infrastructure of providers and commissioning bodies needed to support it?
• District health authorities and regions are now seeing that the scheme’s shortcomings in terms of area planning and public health concerns. The expansion of budget holding may threaten local public health departments and other management posts and functions.
• Then there is the embarrassment factor: private companies formed by budget holders getting preferential treatment from desperate providers; inequality of access to the BH sceme eg. For small practices; inequalities of access for patients to “better” health care in terms of referral freedom, etc.
• Not all GPS will or can become voluntary budget holders. There will always be the ideologically opposed and the disorganised, small practices unwilling to coalesce or to ‘piggy-back’ onto larger budget holders. Budget holding is still the preserve of large, well-organised practices in affluent areas. It has least impact in urban and inner city areas.

Other factors

The Community Care Act is set to operate from April ‘93. Budget holders must buy in health visiting, district nursing, chiropody and dietetics from that date. District health authorities will set up commissioning/purchasing arrangements with community health service units (trusts & directly managed units).

London’s health services are in a mess. The Kings fund has spoken; Tomlinson’s report is causing much debate and the implications of the community care provisions are causing serious concern amongst local authority chiefs. The combining of district health authorities, family health service authorities and local authority planning is in the embryonic stages and full of tension. The government seems to accept budget holding has little to offer in the London situation.

The recent Local Medical Committee conference maintained principled opposition to budget holding but accepted that a substantial minority or GPs were budget holders and the General Medical Services Committee (GMSC) should represent all GPs. Significantly, the GMSC decided before the conference to set up a high-powered committee to consider involving all GPs in the commissioning process.