Health: Doctors welcome chance of new financial clout

The concept of family doctors banding together to purchase more services at local level, as proposed in yesterday's White Paper, is already being tested in a number of areas. Kathy Marks visited one pilot scheme, in Bexhill-on-Sea, East Sussex, to find out how it works.

The scheme is regarded as a model of the way in which the Government wishes to reorganise primary health services. The town's pounds 30m healthcare budget has been devolved to the 25 GPs in Bexhill, who work together to buy in services as locally as possible.

The doctors, based at six surgeries, are full of praise for the system. They say that it gives them the financial clout to negotiate contracts with hospitals that meet the particular needs of Bexhill's 43,000 ageing population. Patients, too, are enthusiastic, having seen waiting times for operations reduced and pioneering screening programmes introduced.

The "total purchasing pilot", as it is known, is an extension of a fundholding project which the town's GPs also went into collectively. At that time, though, they had control of only one-third of the budget. Now, with total financial autonomy, there is far more scope for creativity, according to Dr Peter Dewhurst, who chairs a steering group of four GPs.

Dr Dewhurst says that the scheme, which has been operating for nearly two years, has enabled him and his colleagues to communicate more effectively on clinical issues, set uniform standards of care and monitor the quality of the services that they provide. "We can react to things and change course far more quickly than the Health Authority," he said. "We are like a small motorised boat, rather than a super tanker. We are delivering better services, while managing to balance our books."

The doctors, who remain accountable to the East Sussex, Brighton and Hove Health Authority, negotiate contracts for patients, mainly with the Conquest Hospital in Hastings. But they are also prepared to take their money elsewhere. When the wait for cataract operations at the Conquest became intolerable, they organised for a group of patients to travel together to East Surrey Hospital in Redhill for the surgery.

Dr Dewhurst says that control of the budget enables GPs to negotiate on a level playing field. Since they hold 30 per cent of the Conquest's annual income, their influence is considerable. They have, for instance, managed to persuade consultants to conduct clinics at the Cottage Hospital in Bexhill, rather than in Hastings.

Dr Nick Newell, another of the four "lead" GPs, believes the system makes them more effective advocates for their patients. Marie Parkinson, 70, says: "Patients know a lot more about what their doctors are doing for them, so they are that much more confident."