BMA challenges ministers over health reform

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THE prolonged honeymoon between doctors and the Government is at an end. The British Medical Association yesterday fired its first salvo at ministers whom it accuses of failing to answer its concerns over the planned reform of the National Health Service.

Last November, the BMA warmly welcomed the plans set out in the NHS White Paper to end the internal market and GP fundholding and replace them with "primary care groups" - groups of an average 50 GPs which would control the budget for hospital care in their areas. The aim, endorsed by the BMA, was to end competition and the two-tier service and restore equity and fairness to the NHS.

Yesterday, BMA leaders said that their commitment to the underlying aim remained, but that the Government's continuing failure to spell out the details of how the new groups would work was spreading alarm and despondency among GPs.

Dr John Chisholm, chairman of the GPs' committee, said: "The White Paper was full of froth and short on detail. We have always said the devil is in the detail and the detail is not there. The questions we are asking now we have been asking for months.

"Alan Milburn, the health minister, said the majority of GPs supported primary care groups. I believe the majority of GPs are anxious, worried and uncertain."

Dr Chisholm said that GPs were seeking assurances on five major points, including whether the cash-limited budgets for the primary care groups would restrict GPs freedom to prescribe and refer patients as they saw fit, whether they would inherit the debts of overspending health authorities whose budgets they took over, and what would happen to patients of groups whose budgets ran out before the end of the year.

Dr Mac Armstrong, secretary of the BMA, said: "In 1990 we knew exactly what the [former Tory government's] proposals were [for introducing the internal market] and we opposed them. Now we are saying we have no idea what the [present government's] proposals are and we are refusing to sign up until we do."

The BMA warned that the Government's tight timetable for setting up the primary care groups, which must be formed by July and are expected to come into operation from 1 April 1999, could falter if the required assurances were not forthcoming.

Alan Milburn said that the reforms were "a unique opportunity for GPs to overcome the fragmentation and divisions that fund-holding brought in the past".