Traces of old ideology in Labour's policy on NHS reform

From Dr T. Richardson

Sir: Labour has proposed much on health care that makes ideological rather than practical sense (report, 30 June). They will abolish fundholding because it creates a two-tier system. Yet there is no evidence that the NHS has ever produced uniformity of availability or quality of care, so picking fundholding from among the many inequalities seems vindictive.

All GPs can fundhold, including small practices who wish to clump together to do so. If there are differences in the services patients receive, it may be due more to the non-fundholders' lack of participation, rather than the fundholders using their patients' share of health care resources more effectively.

Labour accepts the principle of GP commissioning, yet this is exactly what fundholding is. They now propose group GP commissioning, or locality commissioning - the only difference being that a group of GPs will hold a budget and be able to commission rather than individual practices. Yet GPs do not generally work well together, being independent practitioners. Unfortunately, committees by and large stifle initiative and entrepreneurial activity, increase bureaucracy and take more time to make decisions. They are thus far less effective in formulating change.

Many benefits have arisen from fundholding, especially local decision making, moving secondary and hospital services closer to patients, and expanding and improving general practice and primary health care teams and services.

Many Labour supporters and advisers have been warning their party to be cautious about abolishing fundholding. To now threaten to do so shows Labour's old ideologies dominating the practical needs of a more flexible and patient-sensitive health care system.

Yours sincerely,

T. Richardson

Epsom, Surrey