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GPs buried under trusts' workload dump

Let's get back to the fundholding 'vision'

I see the Department of Health is considering a return to practice commissioning of secondary medical services (News, June 14). It has clearly recognised that secondary care will only become more efficient if a significant element of competition exists in the secondary care market.

As the NHS must remain free at the point of consumption, it is not possible to generate competition through patients paying for NHS services. Fundholding practices have, however, shown they can produce improvements in secondary care services for patients by controlling, to some degree, the latter's budgets.

A principal reason why fundholding in its original form did not transform the behaviour of secondary care was because participation in it was voluntary and partial.

If all practices had become fundholders it would have been much more successful and equitable for all patients.

Experience in Northern Ireland and elsewhere showed the development of a 'multifund' involving a large number of practices was very successful. Local practices engaged with their PCOs could easily replicate this now.

It would be most unfortunate if medical political dogma did not allow this to happen. Perhaps 'spectre' should read 'vision'!

Dr Lewis Miller

Belfast

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