The Health service journal
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The white paper will move the NHS towards an insurance model where a capitated budget will be held by a single agency. Public accountability will be weakened by allowing primary care trusts and PFI hospitals to combine the planning and provision of services. Primary care groups could sound the death knell of equity, universal coverage and care free at the point of need in the NHS.
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The poor image of NHS management is largely undeserved. The greatest expansion in the number of managers took place before the introduction of the internal market. Many of the white paper proposals, including the establishment of primary care groups, suggest a substantial bureaucracy.
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The white paper proposal to fund primary care groups according to a set formula is beset with difficulties. At present there appears to be no suitable formula for allocating funds at sub-district level. Applying to primary care the national formula now used to allocate funds to health authorities would change current spending considerably and could lead to greater inequities.
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By establishing separate timetables for senior house officers and registrars, an obstetrics and gynaecology department has been able to reduce out-of-hours work while offering training relevant to the doctors' proposed careers. Following the establishment of a daily, open-access gynaecology clinic, extending the role of midwives has reduced the out-of-hours workload of junior doctors. Emergency admissions, a major feature of out-of-hours work, have fallen by a quarter.