GP scheme improves care for all

In Nottingham a group of 200 GPs caring for nearly 400,000 patients works through an elected forum with the local health authority to buy care for their patients, writes Nicholas Timmins.

They claim many of the advantages of fundholding. Physiotherapy is available in all the practices, out-patient waiting times have been cut and the local trusts' services for ophthalmology, ear nose and throat and orthopaedic surgery improved as the commission has made changes sought by the GPs.

"The difference," Dr Ian Trimble, the GPs' liaison officer claims, "is that when we make changes we make them for all patients - there is no two-tier service.

"In addition we look at the whole service - not just the 30 per cent of care that fundholders buy. We don't just deal with the nice easy bits like hips and cataracts, but we are involved with the health authority in commissioning all the difficult nasty ones - cardiac surgery, intensive care, mental illness and head injuries."

The GPs claim running the system their way costs about pounds 66,000 a year against pounds 1.8m if they were all fundholders.

But there are disadvantages, for which Dr Trimble blames the Government. The GPs cannot switch money between drugs budgets and other budgets because that would be illegal - despite fundholders being encouraged to do so. "It is one rule for them and another for us," he said.