Patients of fund-holders 'get priority': Consultants' leaders say 42 per cent of hospitals are running a two-tier service

MORE THAN four out of ten hospitals are running a two-tier service in which the patients of GP fund-holders get priority, the British Medical Association said yesterday.

A survey covering 173 acute hospitals showed that 73 of them - 42 per cent - were offering fund-holders services which were not available to other patients, John Chawner, chairman of the BMA's consultants' committee, said. Of those, 41, or more than half, were offering faster admission - either as a matter of policy or because the hospital had run out of funds from health authority purchasers.

However, Dr Brian Mawhinney, the Minister of Health, said ministers had seen 'no evidence' of a two-tier service. He argued that 'where a district health authority contract has been completed or moved', then the hospital had 'spare capacity'. Fund-holders could then contract to use that for their patients, he said.

Mr Chawner said it was true that contracts were not being broken to give the patients of GP fund-holders an advantage. 'But our survey shows that fast-tracking is happening throughout the year in some hospitals, while in others it is occurring when funding from the main purchasers runs out part-way through the year.' As a result, consultants were being prevented from offering treatment to some patients, while treating others who were less seriously ill.

'Previously we always decided treatment on clinical grounds - treating first the patient who was in more pain or in more danger. That has now stopped, and this puts doctors in a tremendous dilemma. Consultants are unanimous that what is needed is not admission to treatment according to contract, but according to clinical need.'

Jim Johnson, deputy chairman of the consultants' committee, said the reality was that 'two patients with the same condition, or even where one has a more serious and distressing condition than the other, are in a position where the one with the lesser condition can be seen next week if their GP happens to be a fund-holder, while the one with the more serious condition can wait a year or more if their GP is not a fund-holder. I can find no grounds whatsoever, moral or otherwise, to justify that. Patients are not being treated equally.'

According to the BMA's survey, 7 of the 41 hospitals which were admitting fund-holders' patients faster were doing so routinely because they had agreed that in contracts with the GPs. Others had done so because they had run out of money from the district contracts.

In another 27 hospitals the BMA said fund-holders' patients were getting faster out-patient appointments.

Suggestions that hospitals should better pace their district health authority work over the year to avoid running out of cash were rejected by Mr Johnson. That meant doctors saying to patients: 'I could admit you in a couple of weeks, but I am going to make you wait four months because that will disguise the under-funding of the NHS.'

Mr Chawner said a 'level playing field' was needed between GPs. One way of achieving that would be for fund-holding GPs to pay for their emergency admissions, which at present district health authorities pay for, limiting the cash they have left to buy waiting-list work for non-fund-holding GPs.