Back to the future with cottage hospitals

Health White Paper: GPs, dentists and pharmacists see benefits both for themselves and patients

Family doctors, dentists, and pharmacists yesterday gave a cautious welcome to the Government's new vision of primary care which gives them greater freedom in the way they practise, promises more choice for patients and better tailoring of services to local need.

In stark contrast to the confrontational approach adopted by his predecessors and eschewing the imposition of new ideas, Stephen Dorrell, Secretary of State for Health, outlined a quiet revolution in which those "at the sharp end seize the initiative".

Implementation of the changes in the primary care White Paper, Choice and Opportunity, launched yesterday, will only follow if voluntary pilot-schemes and evaluation of the Government's proposals prove their worth, Mr Dorrell promised.

One of the most dramatic proposals is for a change in GPs' contracts which will speed the growth of "super-surgeries" or cottage hospitals offering a range of healthcare including minor surgery.

Currently all family doctors are independent contractors with the Secretary of State and are obliged to provide specific core services, which rules out flexibility, the White Paper says.

Under new legislation, practice-based contracts would be introduced in which a particular practice, rather than a GP, contracts with a health authority to provide services for a local population. It will allow nurses, therapists and managers to play a more high-profile role and organisations or groups of individuals other than GPs to provide services. These could include retailers such as Asda or Sainbury's, as revealed in The Independent yesterday.

Salaried positions are proposed for GPs employed by a practice, trust or health authority who want to work more regular hours and concentrate on patient care rather than the business of running a practice. This is expected to improve care in inner-city areas which face a severe shortage of GPs.

Another significant development is a single budget for general medical services, hospital and community health services and prescribing which will, in effect, allow some fundholding GPs to become "mini-health authorities" providing all services for their patients.

Greater flexibility for dentists in the crisis-ridden NHS dental service is discussed with a range of pilot schemes for health authorities to buy dental services from local practitioners.

A wider role for pharmacists is endorsed with the creation of incentives for health authorities to buy a wider range of services, including the pharmacy as first stop for the treatment of minor ailments.

The British Medical Association applauded the Government's recognition of the value of primary care. The National Association of Health Authorities and Trusts said the White Paper would mean wider choice and improved value for money.