Medicopolitical Digest

Question marks remain over PCGsWaiting lists cannot be abolished but can be improvedGMC's 1999 election

BMJ 1998; 317 doi: (Published 26 September 1998) Cite this as: BMJ 1998;317:891

Question marks remain over PCGs

In June GPs' representatives welcomed the government's reassurances on freedom, funding, and control as a result of the establishment of primary care groups (PCGs) (4 July, p 85). But they believe that the NHS Executive's summer guidance on PCGs (HSC 1998/139) issued last month leaves many unanswered questions and will undermine GPs' commitment to the concept.

A motion calling for the implementation date of 1 April 1999 to be delayed was defeated at last week's meeting of the General Practitioners Committee. The committee acknowledged that such a move was impractical as PCGs were part of the flagship policy of the government and any delay carried the risk of a health authority takeover of PCGs. Furthermore, with fundholding and commissioning being run down it would do more harm than good to delay implementation. But speakers at the GPC said that many GPs would be discouraged from taking up the opportunities offered by PCGs. They disliked the tenor of the guidance, which they thought moved away from an agenda of equal partnership between health authorities, PCGs, health professionals, local authorities, and patients to one driven by health authorities through their health improvement programmes.

GPC chairman seeks clarification

The GPC chairman, Dr John Chisholm, has written to the minister for health asking for clarification on the inadequacy of the amount that PCGs have been promised for management costs; the management of PCG overspends; the formal and personal accountability of PCG chairmen for any failings; the question of redundancy costs for fundholding staff; and the establishment of “beacon practices,” about which the GPC was not consulted. The GPC also wants further information on the allocation of resources to PCGs, the introduction of long term services agreements, the remuneration framework for PCG work, and the arrangements for incentives at practice level.

PCGs are expected to remain within their budgets throughout the year, despite the fact that most health authorities are in debt. The GPC believes that the minister's two rules—that PCGs should stay within their budgets and that patients should get the drugs they need—are incompatible. Dr Chisholm admitted that in some areas it was difficult to find doctors to sit on PCG boards, but this was unsurprising when they did not know what the time commitment and workload would be, and what the arrangements were for remuneration, superannuation, and cover. There was criticism in the GPC that PCGs would not be piloted as fundholding practices were, but it was pointed out that if most practices went in at levels one or two for the first year they would not have responsibility for their own budgets and would virtually be acting as pilots. The GPC plans to issue guidance shortly to local medical committees and the chairman said that he would consider writing to all GPs.

Waiting lists cannot be abolished but can be improved

Waiting lists cannot be abolished, even with limitless funding, according to the Joint Consultants Committee, but can be improved.

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The committee has pointed out that patients cannot be seen and treated at the time of their first consultation, but in guidance issued this week the JCC recommends improvements that could be made to alleviate patients' anxiety and reduce the risk of their condition deteriorating.

The JCC says that patients waiting to see a hospital consultant for an opinion should be categorised and recorded by GPs. Emergencies must be seen immediately; urgent cases must be seen within two weeks; and other patients should be seen within one month, but always within three months.

All diagnostic investigations for urgent problems in primary or secondary care should be started and reported on within two weeks of a consultation. Subsequent investigations should begin and be reported on within two weeks of their request.

The maximum acceptable waiting time for admission to a hospital for a diagnostic or therapeutic intervention should be recorded against each patient's name on the waiting list. Emergencies should be admitted immediately and urgent cases should be admitted within three months of being placed on the waiting list. The JCC lists other categories as “soon”—to be admitted within three months of being placed on the waiting list; “in turn”—to be admitted within 12 months of being put on the waiting list (the JCC believes that no person should wait longer than 12 months and the long term aim should be to reduce this to six months); and “planned repeat readmissions for follow up”—should always be admitted within three months of the planned target date for readmission.

The JCC believes that the efficiency of the NHS should not be assessed by the total numbers on waiting lists but by the numbers that have been seen or treated within the specified clinically acceptable time. It points out that operating lists are constructed to contain an appropriate case mix for the available surgical and anaesthetic staff and also to provide an appropriate mix for training purposes. This means that patients cannot always be taken off waiting lists strictly in the order that they went on to them.

GMC's 1999 election

The General Medical Council has published the timetable for the 1999 election: 23 January 1999: Notice of election printed in medical press 19 February 1999: Last date for return of nomination papers 3 to 7 May: Dispatch of voting papers 4 June: Last date for return of voting papers 25 June: Announcement of results

Medicopolitical digest is prepared by Linda Beecham

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