Letters: Power to the GPs

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Sir: The preview of the White Paper on the NHS (report, 12 November) suggests it will contain interesting and commendable plans. Replacement of GP fundholding with larger groupings of GPs is welcome, as is the idea of a budget combining hospital, primary and community care.

This will indeed break down a "Berlin Wall" but it is a pity that the opportunity is not being taken to remove the other artificial barrier between purchaser and provider. This has no remaining purpose if the market is to go, and if it is retained so will be much of the market and its attendant bureaucracy.

The glaring omission is any reference to democratic accountability. There seems little point in reforming appointments to trust boards and health authorities on Nolan principles if 90 per cent of the budget (and therefore the power) is in the hands of GP collectives. To whom will the latter be responsible? Better to combine the GP collectives with the public health expertise of existing health authorities, which should have boards properly accountable to the people of the area.

Removal of competition between trusts probably removes the need for trust boards, with further savings. The tighter management from "the centre" which is envisaged as replacing that competition raises the question of where that managerial function will lie. It strengthens the argument for a powerful and accountable health authority.

Peter Fisher

Chairman

National Health Service Consultants' Association

Great Bourton, Oxfordshire

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