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When push comes to shove, our cash always ends up in secondary care

I refer to your news report that enhanced services cash 'has already been spent' (May 19). This could either make or break the contract, primary care and maybe the NHS ­

or am I being melodramatic?

Circular HSC2002/012 told health authorities where to put the money ­ £315 million was identified as the minimum expected spend within the main allocation on GMS enhanced services (this year), some £10,000 per GP.

But, as your report states, it has been spent on secondary care. They knew they had the money, they were told where to spend it, and how much, but when push came to shove, all the money ended up in secondary care again.

We had Health Secretary Alan Milburn come to look at our community hospital last year. I told him all the money had ended up in secondary care in 2002/3. He told us it is up to PCTs to take hold of the reins and direct the development. But this simply doesn't happen. The hospitals say we need £X and PCTs are told to give it to them ­ even the money for enhanced services, money that should have ended up in GPs' pockets. If GPs were now seeing thousands of pounds of this new money coming in to practices from April, as it should have done, do you really think we would be having this anguish over the contract? I think not. You see the money, it changes things.

Without a national contract GPs will just be the beggars at the table, while the money is stuffed into the failing-to-perform secondary care sector. Result? End of the NHS?

Maybe not ­ but just maybe, if primary care doesn't get the resources.

Dr John Ashcroft

Ilkeston, Derbyshire

Postscript

The chief executive's bulletin has told PCTs to provide a return of how much money is being spent of this £315 million.

Finance officers will make a return, the numbers will add up, but it will not be the same money, they will cadge money already in the system ­ such as incentive scheme monies and so on.

The Department of Health will say 'it's alright, the money has reached primary care' when it's actually in secondary care!

Then the GPC will get upset...

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