Letter: NHS hard times

Sir: I was surprised Sue Arnold (Comment, 28 November) did not understand the link between upgraded GP premises with elegant furnishings and the cut-price, factory-like day surgery on Dickensian hospital wards that she and her aunt experienced.

The connection is of course the NHS internal market.

GP fundholding transfers money from already under-funded health authorities to some GP practices for them to purchase elective surgery and other clinical services for their patients from hospitals, and to develop their own practices.

GPs are semi-independent contractors to the NHS and usually own their premises, equipment and furniture. Their priorities naturally focus on their own practices and so they demand cut-price services from hospitals so that as much of their funds as possible are spent on primary care.

Capital charges of 6 per cent of NHS trusts' assets based on inflated 1980s property prices were levied annually on all hospital trusts. These were returned to the Department of Health. This "tax" had to be paid out of earnings from GP fund-holders and health authorities.

NHS hospital trusts must use "businesslike" methods to provide surgical and medical services to the internal market. Budgets have been balanced by cutting the price of elective surgery to the minimum and by reducing beds. Mixed-ward policies maximise the occupancy of a diminished number of available hospital beds.

Pity Mr Dobson in his forthcoming battles to abolish GP fundholding and to restore NHS hospital nursing. When the New Tories come to power Sue Arnold should get private health insurance. She may have no choice.

Dr HIRAM BADDELEY

Harrow-on-the-Hill, Middlesex