GP fundholding to be expanded

VIRGINIA BOTTOMLEY is to announce an expansion of the controversial fundholding system for family doctors at the Conservative Party conference next month.

Dismissing Labour allegations that the Government is creating a two-tier health service, the Secretary of State for Health is planning to reduce the threshold of 7,000 patients for GPs to become fundholders to enable smaller practices to offer the advantages of the system to their patients.

In an interview with the Independent, she said she wanted to see three steps - a new lower threshold enabling GPs, possibly in consortiums, to become fundholders; maintaining the existing fundholding level; and a higher level for those GPs who wanted to offer a wider range of services, including operations now carried out in hospitals, to their patients.

About 30 per cent of patients are covered by fundholding GPs, due to rise to 40 per cent with the next wave in April 1995, but ministers are seeking to increase it by the general election to more than 50 per cent. Mrs Bottomley believes that the next wave of changes will make it impossible for Labour to abolish fundholding, which it has alleged has led to queue jumping by patients of fundholders.

GPs who have control of their own National Health Service budgets are able to 'buy' services on the NHS on behalf of their patients direct from hospitals.

Their NHS contracts with hospitals enable them to refer patients for operations, when the funds of district health authorities have run out.

It has been alleged that fundholders have been given priority by hospitals anxious to keep their custom.

Rejecting the criticism, Mrs Bottomley said: 'Fundholding has changed the balance of power in the health services towards GPs as the advocate for patients.

'Undoubtedly, it has given the family doctor service new leverage to challenge some of the powerful establishments. It is the small platoon challenging the big batallions.

'I want to take that further. I want to encourage more people to join fundholding in a number of ways so people can join up at the level which is most appropriate.'

She will also announce a reduction in waiting time targets under the patients' charter which guarantees that patients will wait no longer than 18 months or two years for operations.

Mrs Bottomley was keen to follow Cabinet strategy to seek credit for the Conservatives for improvements in the NHS. 'We are seeing results in terms of the fall in waiting times, the quality and quantity of patient care, and there is more to do in areas such as out-patient waiting times. Two years ago, three in five out-patients were seen within half an hour. Four out of five are seen within half an hour now. I want to see it get better.'

Mrs Bottomley, who has attracted heavy criticism, will introduce a Bill in the Autumn to abolish the NHS regional authorities and allow the merger of the lower tiers, district health authorities and family health service authorities, responsible for GPs.

The Government was accused yesterday of pursuing an agenda which will produce a health care system similar to that which the United States is desperately trying to escape, writes Nicholas Timmins.

The commercialisation, fragmentation and 'creeping privatisation' of the NHS was undermining the 'culture of care and service' in the system, David Blunkett, Labour's health spokesman said, as he published a document detailing the 'explosion' of private health care under the Conservatives.