Letter: Power to the GPs

Sir: While the broad thrust of the proposed NHS reforms revealed in The Independent on 12 November is to be welcomed, they raise a number of concerns.

Reducing bureaucracy and abolishing the competitive ethos that forces hospitals to try in effect to put each other out of business can only be good. Transferring the power to set clinical priorities to those who most fully understand the problems is also good, but to give almost complete budgetary control to one section of the NHS - general practitioners - may produce new problems.

While GPs have perhaps the best overview of the local population's needs, nursing and allied health care staff and hospital doctors will have an equally valid perspective. To exclude all these others from spending decisions would risk recreating many of the antagonisms that existed in the days when power to influence spending was seen to rest disproportionately with hospital consultants.

Moreover, GPs are the only individuals in the NHS who, in theory, can gain financial profit from the allocation of NHS funds to facilities in which they have a financial interest. If they are to have significant budgetary control of the NHS, consideration should be given to making them salaried employees, in line with everyone else.

Dr ANDREW A JEFFREY

Roade, Northamptonshire