Letter: Fundholding logic

Sir: I was somewhat surprised by the tenor of your account of the Audit Commission's recent reports on the NHS, a small part of which refer to GP fundholding ('GP fundholding system 'should be phased out' ', 26 May).

So far from proposing that fundholding be 'phased out', as I read it, they come to the opposite conclusion. The following paragraphs come to a very similar conclusion to my own research.

228: Current experience of the fundholding scheme suggests there is benefit from this dual commissioning arrangement. GP fundholders have shown their ability to use funds imaginatively for certain services such as routine elective admissions, and to stimulate change in

providers.

Co-operation between districts and GPs was important and should be monitored by Regions, but:

231: The presumption should be in favour of practice-based commissioning, ie, GPs selecting the best package of health care for each patient within an overall practice budget.

232: There is a compelling logic about more local involvement which is missing from the present arrangements.

Precisely.

Yours sincerely,

HOWARD GLENNERSTER

Department of Social Science

and Administration

The London School of Economics

and Political Science

London, WC2

28 May