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Primary care groups frustrated by variations in funding

BMJ 1999; 319 doi: (Published 16 October 1999) Cite this as: BMJ 1999;319:1026
  1. Gavin Yamey
  1. BMJ

    The NHS Executive was heavily criticised by primary care groups in England for its unilateral imposition of excessive rules and regulations, at the second annual conference of the NHS Alliance in Birmingham last week.

    The executive has issued three sets of guidance outlining the roles and responsibilities of primary care groups. These cover local health improvement programmes, health service development through cost effectiveness initiatives and clinical governance, and the commissioning of services.

    But Dr Michael Dixon, chairman of the alliance, which represents over 200 of England's 481 primary care groups, advised participants: “Don't bother with any guidance that does not benefit your patients. Neither the government nor the Department of Health has any right to impose rules and regulations unilaterally on those who are doing the work.”

    Many groups expressed frustration at the speed at which they are expected to follow central directives. “We are harangued for being recidivists,” said Dr Dixon, “for dragging our feet on some proposals—proposals on which we were never properly consulted.”

    Although there was overwhelming support for the way in which primary care groups are reshaping the health service to respond to local needs and priorities, there was criticism of the large variation in budget allocations between groups and in the management allowance allocated by health authorities.

    A new questionnaire survey of groups by the NHS Alliance shows that management allowance ranges from £1.90 to £7.00 per patient. Craig Oates of the NHS Executive admitted that some of these variations were “inappropriate.”

    A major issue facing primary care groups is whether they should apply to become primary care trusts in April 2000. Trusts will take on responsibility for commissioning the broad mass of hospital and community health services, and they may give primary care groups greater independence.

    Many groups had no interest in applying for trust status, a still untested system, but felt pressurised by the government to do so, several speakers claimed at the conference.

    John Denham, minister of state for health, tried to reassure these groups, saying, “we will not be in the business of steamrolling primary care groups into becoming primary care trusts. Trusts will only be established where there are clear benefits for patients, local health professionals, the local health economy, and the wider community.”

    The specific challenges facing primary care groups in London have been highlighted in a new report from the King's Fund. The report argues that “the fair distribution of resources between practices is vital if all people living in London—and especially the most disadvantaged—are to get access to high quality primary care.”

    The NHS Alliance report, The Development Needs of Primary Care Groups, is available via the alliance's website ( Developing Primary Care in London is available from the King's Fund (tel: 0171 307 2591), price £5.99.

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