Intended for healthcare professionals

Rapid response to:

Letters Coalition plans for English NHS

A poisoned chalice?

BMJ 2010; 341 doi: (Published 04 August 2010) Cite this as: BMJ 2010;341:c4179

Rapid Response:

Hidden agenda

Dear Sir

Of course Mark Strong is right to call the new plans for the NHS a
chalice but there are a few other points which worry me about the plan to
devolve funding to individual practices.

1. How is the funding to be carved up? Will the funding be per
registered with the Practice? This will unfairly penalise the Practices
serve deprived areas.

2. At present the funding is handled at PCT level. PCTs will
probably have at
least 2 accountants, 2 managers and one lawyer specifically to ensure that

nothing comes back to hit the PCT. These 5 posts will disappear with
consequent savings for the government. However the Practices will need to

employ at least 1 accountant, 1 manager and 1 legal person for the same
purpose. Even if practices combine so that a single PCT becomes 10
groups, the saving on the salaries of 5 people will be replaced by the
of 30 people. Some saving!

3. Where is the funding for these additional essential
administrators? Is it to
be covered within the devolved pool of health care money or will the
have to cover this within their expenses? The first option will mean less

funding for health care and the second option will mean an effective pay
for the medical staff.

4. The idea of devolving the funding looks very sensible at first,
and would be
so if medicine ran like factories. However what will happen if there is
epidemic in one particular funding group? This could put such a strain on
group that it would go bankrupt or fail to be able to keep up the rest of
medical care. What happens then? The reason for having funding covering
large areas such as Health Boards, or larger, is to spread the risk.

Overall it looks to be a neat way of cutting government costs and
shifting the
blame for any shortcomings onto the medical staff.

Yours faithfully

Dr Evan L Lloyd

Competing interests:
None declared

Competing interests: No competing interests

09 August 2010
Evan L Lloyd
72 Belgrave Road Edinburgh EH12 6NQ