Published: 02/06/2005, Volume II5, No. 5958 Page 19

Dr Richard Turner, director of public health, South Leeds PCT

Anyone who holds a budget has to live with the consequences of spending it, for better or worse.

The smaller the budget, the less resources are available for comparative evaluation of local services, price negotiations and proper complaints procedures.

Small budgets can also fall victim to the trend of large suppliers taking over smaller ones and leaving purchasers with only one choice.

My concern is that - just as has happened with small fruit shops, grocers, motorway service cafés and the like - small nursing homes will be taken over by by big chains.

This has already happened with independent chemists, out-of-hours care providers and cleaning firms.

When the provider is publicly owned there are mechanisms to safeguard quality, and even a degree of accountability to the press.

But how much is leaked about the quality or comparative cost of services in private companies?

GPs in large practices or locality groups (or in good PCTs) are in a reasonable position to commission, but where does this leave patients?