Chaos looms over GP fundholding hy hy

Queen's Speech: Legislative delay threatens to undermine NHS reform as Government sets out wide-ranging agenda

THE GOVERNMENT'S legislative package to be unveiled in tomorrow's Queen's Speech came under fire last night on a range of fronts as it emerged that plans to scrap GP fundholding were in disarray.

Frank Dobson, the Secretary of State for Health, will announce plans for a shake-up in every family doctor surgery in the country from 1 April. Fundholding, giving GPs powers over their own budgets, is to be replaced by a system of co-operatives, in which GPs band together to order treatment for their patients from hospitals.

But ministerial sources have told The Independent that the NHS Modernisation Bill, to be included in the Queen's Speech, will not have become law in time. It means there will be no legal authority to carry out the changes by the launch date. "We will have to ask the doctors voluntarily to agree to the changes," said a source.

Shadow primary care groups have already been set up, and will continue until the legislation gives them legal backing. But some fundholders may try to hold on to their autonomous powers to run their own budgets for patients, unless they are forced by law to stop.

Ministers were urged to postpone the date of the launch by Simon Hughes, the Liberal Democrat health spokesman. "These plans have become increasingly unpopular with the profession and it is inconceivable that they can be legislated for in time for the launch.

"It is a mess. The Government's launch date should be put back to allow for proper time for Parliament to its job."

Alan Duncan, Tory health spokesman, said: "It's completely shambolic. The Government's strategy is in disarray. It is going to be a complete mess."

The Department of Health also came under fire from the Tories and motoring organisations over the well-trailed plans to include new powers for NHS trusts to charge insurance companies for treating motor accident victims.

There were warnings yesterday that it will lead to a rise in insurance premiums for all drivers, regardless of whether they have an accident or not, as insurance companies try to meet the additional costs.

An NHS unit will have responsibility for collecting the payment of pounds 295 for outpatient treatment and up to pounds 2,949 for inpatient care.

Mr Dobson will defend the move on the grounds that insurance companies should already be paying the charges but are escaping because of the bureaucracy, which is to be streamlined.

"It will be regarded as another attack on rural interests at a time when the rural economy is in great trouble," Michael Ancram, the Tory party chairman and the MP for Devizes, told Sky's Sunday With Adam Boulton programme.

Lord Irvine, the Lord Chancellor, raised the hackles of leading lawyers by persuading the Cabinet to include in the Queen's Speech the Access to Justice Bill. This Bill is to cut the cost of legal aid by limiting the defence work to an approved "cab rank" of lawyers on block contracts, as reported in The Independent on Sunday.

Roy Amlot QC, first senior prosecuting counsel to the Crown at the Central Criminal Court, and a former chairman of the Criminal Bar Association, said: "What must not happen is that the public don't get the right sort of service because the costs are so carefully controlled. That is what we are arguing fiercely about."

Campaigners also protested about the failure to include a Freedom of Information Bill in the Queen's Speech.

Forty-six organisations - including The Independent - have signed a letter to the Prime Minister protesting at the delay.

Steve Richards

Review, page 3