Practice did not match rhetoric: Fundholding dream became a bureaucratic nightmare for four GPs, reports Judy Jones

JOHN WILLIAMSON and his three GP partners in Runcorn, Cheshire, have had enough of fundholding. 'We thought it would be so good for patients, but the practice never lived up to ministers' rhetoric,' Dr Williamson said.

He and his colleagues at the Murdishaw Health Centre, serving 9,000 patients, were among the first in the country to join the fundholding scheme. They withdrew last month, beaten by bureaucratic wrangling with the Mersey Regional Health Authority, and by what they suspect were powerful vested interests at the local Halton hospital.

'What we thought we could achieve with fundholding was a shift in the power balance away from hospital consultants towards the patients themselves. Rather than letting our patients take pot luck, we thought it would give us more scope to buy them the services they needed.'

The partners decided that one of the biggest needs was an improved service for patients waiting up to three months for orthopaedic outpatient appointments at the hospital. They decided to bring physiotherapy sessions to the health centre.

'The local hospital quoted us pounds 80 a hour for a physiotherapist, which we thought was excessive, so we set up a company to provide physiotherapy services at the health centre. It was a real success. But the RHA decided that although the earlier treatment we could provide for patients was enabling us to cut the number of orthopaedic referrals to the hospital, we were doing too much.

'We were told the company was taking too much business away from the local hospital.

'We then said we wanted hospital consultants to come out to the health centre for clinics. It's often more convenient for the patients, and GPs like it. We had a gynaecologist, dermatologist, an ear, nose and throat doctor, a general medical outpatients' guy, and a paediatrician. But there has been some resistance among consultants.'

Last December, the region said it was not happy with the health centre's staff budget, and offered only a slight increase on its pounds 1m overall budget for 1993-94. The practice decided to withdraw from fundholding.

'The district health authority is still paying money into our company for physiotherapy, though. The bureaucrats, the FHSA and the RHA, they are only interested in the cash, the figures on paper; they don't care about the quality of care to patients.

'They're very sentitive to criticism though. What they seem to have decided is they don't like doctors having these new powers. They want to take back control. I don't think fundholding will wither on the vine. It'll be strangled at birth, more likely.'