News

Changes in primary care put Labour on the defensive

Recent weeks have seen both significant moves towards the regulation of primary care by the government, alongside a softening of attitude by New Labour towards GP fundholding, which it had previously pledged to abolish.

In October the government published its white paper on the future of primary care, Choice and opportunity. The thrust of the proposals is aimed at introducing a new flexibility into the existing relationships between health authorities and the ‘independent contractor professions’ of general practice, dentristry, pharmacy and optometry. Although details of the contracts have changed, the form of relationship between state and professions has remained substantially unaltered since 1948.

The white paper proposes legislation which will allow a range of pilot schemes to be established for different ways of employing GPs and providing primary care. Ideas put forward include salaried GPs, whether employed by practices, NHS trusts or ‘other bodies’, contracts with practices rather than individuals, and a single budget for all health care which a total purchasing scheme might provide, whether itself or through contracts with other providers.

The proposals also put forward suggestions for widening the role of community pharmacists, and for bringing dentistry into the same contractual framework that health authorities have with other providers.

The overall logic of the proposals is to extend the model of the purchaser-provider split further into primary care services, though it is still not clear how GP purchasing will relate to health authority purchasing.

Meanwhile, the pressure on Labour to accept current fundholding arrangements increased with the publication of a survey carried out by the National Association of Fundholding Practices among its member practices. Seventy one per cent of respondents rejected Labour’s plans to replace fundholding with a system of locality-based commissioning.

The Institute for Public Policy Research, a left-leaning think tank, also urged Labour to allow successful fundholders to continue to run the scheme, until more research was available on the costs and benefits of fundholding.

The response of Labour’s shadow health minister Chris Smith has been to argue for a ‘process of evolution, not revolution’.

It is estimated that by April 1997, 60 per cent of the population of England will have a fundholding GP.