Super-surgeries get ready to operate

Go-ahead expected for new bridge between GPs and hospitals
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The first "super surgeries", intended to bridge the divide between hospital and family doctor care, will be given the go-ahead in a government announcement on measures to deregulate the GP service, expected this week.

Applicants to run the new surgeries have been selected from 560 GP practices and National Health Service trusts and health authorities who submitted proposals to be piloted under the Primary Care Act. The Act, which took effect immediately before the election, was intended to assist the shift of care from hospital to GP's surgeries which Frank Dobson, the Secretary of State for Health, has since proclaimed as the way forward for the NHS.

Yesterday, the British Medical Association warned that the trend to provide more care in GP's surgeries was not being monitored and there was no evidence that it was better for patients. Consultants complained that they spent too much time travelling and GPs said they were required to do extra work without extra resources. Hospitals said that despite the transfer, their workload was increasing.

The new super surgeries, which will operate from next April, will have extra staff, such as physiotherapists and dietitians, and will offer a wider range of minor surgery, consultant-led clinics and care for chronic ailments such as asthma and diabetes. The successful applicants are expected to be entrepreneurial GPs with big practices who are eager to expand the services they offer, are frustrated by existing regulations, and are keen to negotiate contracts locally with health authorities rather than working to the existing national contract.

In addition, NHS trusts and health authorities and some larger practices have applied to hire GPs directly on salaries for specific tasks, such as caring for the homeless, immigrants or refugees. Regulations which require GPs to be self-employed and buy or rent premises have created problems in the inner cities where property prices are high and patients more demanding. Urban GPs have become harder to recruit and a salaried service is seen as the best way of stemming the exodus to the suburbs and the country.

Interest from commercial organisations such as supermarkets and pharmacy chains, widely touted earlier in the year, has disappeared following the Labour election triumph.

It is understood that some of the 560 "expressions of interest" already meet the requirements of the scheme and will be allowed to go ahead while others will be asked to do further work. The first pilots will begin in April 1998 with more ambitious schemes, involving GPs operating "unified budgets" covering all GP and hospital care, deferred until April 1999.

Dr Ian Trimble, a Nottingham GP and adviser to the NHS Executive, said the schemes were expected to cut paperwork and increase flexibility. "The idea is to get GPs working with health authorities and allow money to be moved around so savings on drugs for example could be spent on extra staff," he said.

However, there are fears that GPs hired directly by NHS trusts could feel pressured to refer patients to them, reducing patient choice, and threatening neighbouring practices. Dr Trimble said: "NHS trusts are big powerful organisations and they could offer a GP service as a loss leader, undercutting rivals and squeezing up their income from patients referred."

Christine Wall, assistant chief executive of Liverpool Health Authority, which has applied to hire GPs to work in the most deprived parts of the city, said they would be paid salaries of about pounds 50,000 a year, equivalent to the average GP income. "We want to attract good doctors interested in providing good services who can come in without having to make a financial commitment by buying into a GP partnership and then encourage them to stay."

Knives are out for pay review chairman

Frank Dobson, the Secretary of State for Health, is under pressure from family doctors to axe the chairman of their pay review body, who is also the head of one of Britain's most heavily criticised water authorities.

The knives are out for Brandon Gough, the chairman of the Doctors and Dentists Pay Review Body, who is also the chairman of the Yorkshire Water Authority, which was attacked over water leakages by Mr Dobson in opposition.

The GPs recently narrowly passed a motion of no confidence in Mr Gough, over his board's refusal to accept their demands for a hike in salaries to take account of higher workloads.

Mr Dobson has so far resisted their demands for Mr Gough's head, but he is planning a purge of National Health Service trust board members, appointed under the Tories. He said he did not want to replace "Tory deadheads" with "Labour deadheads" and has ordered that the new appointees should be more accountable and live in the communities they serve, such as local councillors and voluntary workers.