Conservative plans for compulsory fundholding and an end to central targets get mixed response from GPs
Fundholding on Tory manifesto
By Christian Duffin
Fundholding will return if the Conservatives win the next
Outlining their health policy this week, the Tories pledged
to hand more control of NHS
finances to GPs, giving them
direct control over budgets and allowing them to make savings and reinvest as they see fit.
Other policies included scrapping all centralised targets and incentivising GPs via the quality framework to hit local targets based on health outcomes.
Andrew Lansley, shadow health secretary, said: 'We need [GPs] to have incentives to deliver the best outcomes for patients and to be able to do so
by controlling budgets for their patients.'
David Cameron, Conservative party leader, said waiting times under fundholding – scrapped by Labour in 1999 – were shorter than now.
Fundholders also brought down hospital prescribing
costs and cut elective hospital admissions by 3.3 per cent
compared with non-fundholders, he said.
But the plan to revive the fundholding scheme received a mixed response from GPs.
Dr Hamish Meldrum, GPC chair, broadly welcomed the Conservatives' plans, but said GPs had to have their clinical time covered if they were going to do more admin work.
He said: 'You need to look at providing the whole range of resources including adequate data flows about patient treatments, in order to enable GPs to do the job properly.'
Dr James Kingsland, a former fundholder and chair of National Association of Primary Care, said the plans were not hugely different from what was in place now. He said: 'We'd need to iron out previous problems, such as extra bureaucracy and the two-tier system.'
Dr David Jenner, practice- based commissioning lead for the NHS Alliance, said: 'I'm not convinced, because last time half of GPs did not want to get involved in extra work. I could see it working if there was a consortium of GPs doing fundholding for a region.'
Professor Chris Ham,
professor of health policy at
the University of Birmingham, questioned how many GP
practices would be interested.
He said: 'There can be a lot of hard work. Also, some GPs are skilled in managing budgets, while others are not. It would be wrong to put all the eggs in a fundholding basket.'
Tories on health
• 'All GPs' to become fundholders. Budgets taken away from PCTs and given to practices.
• Scrap central targets. Replace them with local targets focused on 'health outcomes'.
• Change the QOF so it focuses on these outcomes targets rather than on 'process' targets such as keeping registers.
• 'Patient-reported outcomes'
to have a greater influence on