BMA offers guidance on secondary care by fundholders

Since April 1993 general practice fundholders have been able to provide some secondary care services in their practices. The BMA's Central Consultants and Specialists Committee has consulted the medical royal colleges and the General Medical Services Committee and prepared guidelines on the levels of training and experience that might be appropriate.

Fundholders have to obtain regional consent in writing before providing any services or seeking reimbursement, but the CCSC has found that in many cases regional health authorities have not established appropriate approval mechanisms. The committee believes that consultants in the relevant specialties and general practitioners should be involved in all stages of the approval mechanism. Applicants should be able to show their training and competence in each procedure and give numbers of procedures undertaken of a similar nature and current specialist commitments.

The Association of Anaesthetists is preparing guidelines on the provision of general anaesthesia outside hospital. In the meantime, the CCSC believes that fundholders should adhere to the guidelines in the Royal College of Surgeons' booklet Guidelines for Sedation by Non- Anaesthetists.

The guidelines cover procedures in gynaecology; ear, nose, and throat; urology; pathology; ophthalmology; general surgery; and orthopaedics. In many instances the guidelines emphasise that resuscitation facilities and staff trained in life support must be available, particularly if the procedure is carried out under sedation.

Copies of the guidelines are available from the CCSC secretariat, BMA, BMA House, Tavistock Square, London WC1H 9JP.