Sir: There is a simple error of logic in your theory that because GP fundholding works, we need more of it. As you rightly point out, fundholding works at the expense of the non-fundholders. Fundholding patients compete for hospital resources and are sometimes given priority over non-fundholding patients because they bring in more money to the hospital trust. If all GPs became fundholders, all would compete equally. No one would be better off than anyone else, or than they were before fundholding was established, but at least the system would be fair.
Your telling but under-emphasised phrase, "In some cases, clinical priorities have been distorted", sums up the weakness of fundholding as a basis for purchasing health care across the nation. Hospital trust managers and the "all-powerful hospital consultants" (your phrase) who work for them, are given two conflicting priorities: to treat according to clinical need and to maximise trust revenue. As long as fundholders and non-fundholders, or their equivalents, exist, there will be pressure on hospital trusts to distort clinical priorities.
P. D. O. DAVIES
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