Apologies for the length of this but we recently sent this letter to our CE
of the HA; it was signed by the GPs of several practices in our area.


1 April 1998
Dear
The recent discussions about Primary Care Groups in Portsmouth have been
dominated by the agenda of the Health Authority (on behalf of the
Government) and the Locality Commissioning Pilot.  Since we are given no
practical option other than to join together to form a Portsea PCG we wish
to have our views and agenda clearly understood as well.
The aspirations of the Commissioning Pilot are admirable but the creation of
PCGs may produce as many obstacles as opportunities to achieving them.  We
understand why the Health Authority has to sell us the reforms with such
enthusiasm and to accentuate the positive whenever possible.  However, as
self employed business people we have to look at all potential sequelae of
the changes and these include some fundamental threats to our practices and
the people working in them.
These include the following:
? As we are obliged to take increasing part in directly rationing healthcare
for the community it will undermine our role as health advocate to our
individual patients.  This is a threat to sound ethical practice.

? There is a real danger that GMS cash limited funds will be raided to fund
hospital and community health services and that it will be difficult to
protect the necessary and already often inadequate funding of premises,
staff, IT and equipment from the infinite demand for new and better patient
services.

? Our status as Independent Contractors could come to an end

? There will be significant medico-legal repercussions following the shift
of fiscal responsibility from Health Authorities to a PCG.  The brunt of the
cost of this may be borne by the GPs and their defence organisations.

? Underlying the agenda of the government is their desire to cut public
spending.  After pump priming their reforms we suspect they will fail to pay
for the true costs of managing a PCG and progressively whittle away budgets
forcing uncomfortable cost cutting and service shrinkage that can be
conveniently blamed on the shirking staff left who are failing to “maximise
their contribution”.
As it seems we must, we will join a Portsea PCG with the intention of trying
to maintain high medical standards in good local surgeries whilst
contributing to new developments as appropriate.  But we will oppose change
that amplify the threats identified above which would lead to the
destruction of our livelihoods.



Dr Lester Russell
[log in to unmask]
The Osborne Practice
25 Osborne Road
Southsea
Hants
PO5 3ND
01705 821371
Fax 01705 291076





%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%