Chief Political Correspondent
Hospital budgets could be cut to pay for more operations performed in local surgeries in plans which could change the face of family doctor services.
The transfer of resources from hospitals to GPs has emerged as one of the leading demands from family doctors in a "listening exercise" being conducted by Gerry Malone, the health minister, to pave the way for the changes.
However, there could be a row over the loss of funds by hospitals, as the resources are gradually switched to GPs.
Mr Malone has also heard claims by GPs that hospitals are already overcharging GPs for services in the "internal market" to compensate for the loss of resources to GPs.
The proposals will be put forward in a Green Paper expected in late May. Stephen Dorrell, the Secretary of State for Health, believes GP fundholding has proved so successful that the benefits should be built on.
A poll of fundholders published today shows that 40 per cent complained about the charges being increased after their budgets were set.
Mr Dorrell is studying an expansion of "total fundholding" from a few pilot schemes, under which GPs would control the whole of the budget for their patients, including resources which normally go to hospitals.
Many GPs are reluctant to take on extra work, because they feel they are overloaded.
The Government is preparing to offer GPs more money after the general election. As private contractors to the NHS, they are seen by Tory strategists as important opinion formers.
The expansion of primary care is also being used by the Tories to put pressure on Harriet Harman, Labour's health spokeswoman, over her party's plans to replace fundholding with joint commissioning.
The National Association of Fundholding Practices issued a poll to coincide with the launch of another wave of fundholding practices today taking the total to 13,000. The poll was used to show that fundholders would not want to be replaced by joint commissioning - in which all GPs co-operate to "buy" services from hospitals.
GPs could be given the funds, now given to hospitals, for routine operations, such as bone setting. That could relieve the pressure on accident and emergency units, but it could lead to more mergers, or closures.
The Prime Minister signalled the changes could go further by allowing GPs to take over cottage hospitals. The aim is to create "hospitals without walls" in the community, in which operations can be carried out to avoid patients spending long terms in general hospitals.
The British Medical Association, meanwhile, is concerned that the drive by ministers to expand the role of GPs will undermine their commitment to generalised provision of service.
The National Asthma Campaign has called for an overhaul of the discount system for prescriptions after warning that many who suffer from the condition cannot afford the new prescription charge of pounds 5.50 per item.Reuse content