Column
News from nowhere
healthmatters’ own straw poll of hospital trusts on GP fundholding anticipated the Audit Commission’s damning criticism of their inadequate drive and limited ability, but in more forceful language.
When asked to comment on local fundholders, one eminent and normally mild mannered medical director of a trust somewhere up north said: ‘Stupid, arrogant, greedy bastards’. Their fundholding managers were, she added, mostly ‘not up to working on a supermarket checkout’.
This, she said, was pretty much the view of all her colleagues, and seemed trusts. The need for continuing professional collaboration prevented such assessments becoming public, but the destabilisation of trusts and the real prospect of a melt-down in the NHS market was fraying tempers and undermining diplomacy.
The Audit Commission’s report is timely, because it punctures the bubble of hyperbole around fundholding at exactly the right moment. The NHS Executive knows that fundholding is a problem, not a solution and that ill-considered and sudden switching of contracts by some fundholders is undermining local hospital and community services just at the moment when trusts are becoming acutely short of cash. The whole strategy of a ‘primary care led NHS’ is also about to founder, mainly because of the miserable results of the fundholding adventure.
Fundholders, the Audit Commission found, were making purchasing decisions that did not represent the best value for money, tended to stick to old patterns of working with traditional local hospitals, knew little about clinical effectiveness, and favoured services like counselling and complementary therapies despite lack of evidence of their value.
The Commission urged fundholders to invest in improvements in patient care before investing in their own premises, which they own and from which they gain personal benefit.
Competition was not working, with little sign of patient movement towards fundholding practices — not surprisingly, given the inertia of most fundholders and their inability to improve services significantly.
This is heartening. We can sigh with relief when Major leaves 10 Downing Street and again when fundholding is put out of its misery. Many fundholders will join us.
