Sir: The Audit Commission's report on GP fundholding ("Price of reforms outweighs results", 22 May) offers an opportunity to consider wider issues of how GPs should be involved in reviewing and planning the services available to their patients. GPs are in a pivotal position in the health service and are a major factor in its cost-effectiveness. Their understanding of how services match up to patients' needs is a powerful way to shape improvements.
GP fundholding is the only mechanism which the Government has supported for mobilising this force for change. It is unpopular because it requires general practices to set up as independent purchasers in a competitive market system. It is seen by many as bureaucratic, divisive, and expensive. It is unsurprising that many GPs have entered the scheme reluctantly and seem not to be achieving as much as might have been hoped for.
GP commissioning by contrast is a grass roots response by GPs to the possibilities of the purchaser- provider divide in the NHS. It is not the invention of a political party although Labour has seen its merits and selected it as its own approach. GP commissioning groups are representative groups of GPs who work with their health authority to plan, provide, and monitor services. The purchasing function is discharged by the health authority leaving GPs free to play to their traditional strengths and training.
GP commissioning, despite a lack of any Government support of funding, has established itself as an effective mechanism.
Dr WILLIAM A WARIN