Dorrell denies rise of two-tier NHS

Stephen Dorrell, Secretary of State for Health, yesterday dismissed the concept of a two-tier health service - with preferential hospital treatment for the patients of fundholding GPs - as a "profoundly wrong" analysis.

Mr Dorrell said the onus was on non-fundholding GPs to demand the same improvements in hospital and community services for their patients.

He told the conference of the National Association of Fundholding Practices, in Harrogate, North Yorkshire: "The role of fundholding is not to allow a two-tier service - it is to reinforce initiative and strengthen commitment to innovation."

There are now more than 10,500 fundholding practices which manage their own budgets and buy packages of hospital care and some community services for their patients. From April 1996 more than half the population of England will be cared for by GP fundholders. Non-fundholders rely on local health authorities to buy health care services for their patients.

The Independent on Sunday reported that non-emergency surgery for the patients of non-fundholders in Salisbury, Wiltshire, has been cancelled for at least six months because the health authority cannot afford any more care. Patients of GP fundholders are being "fast tracked", giving rise to claims of a two-tier health service.

Mr Dorrell accepted that fundholders had more leverage with hospitals. "Fundholding certainly empowers the GPs in a way that makes it easier for them to improve services available to their patients. But to interpret the process of allowing the emergence of a two-tier service is to ignore the response of other GPs . . . to demand that improvements are made available to their patients as well."