Guidance gives the go-ahead for Welsh local health groups

The equivalent of the guidance recently issued on English primary care groups has been welcomed by managers and GPs as a 'sensible way forward'.

But concerns have been raised about a lack of clarity on key details, including the remuneration GPs and others will receive for becoming involved in LHG boards.

Fiona Peel, chair of Gwent health authority and the NHS Confederation in Wales, said: 'We have to have people in post in six weeks' time, which is going to be quite tough.

'Local medical committees are doing a lot with us to recruit GPs, but it is difficult because of the question of expenses and other matters.'

Gruff Jones, deputy chair of the British Medical Association's Welsh GP committee, said: 'The biggest problem is where the volunteers are going to come from.'

In line with the structure set out in the Welsh health white paper Putting Patients First , the guidance says all local health groups will start at level 1 - advising HAs - next year.

'In the first three months of 1999 we will consult on a set of criteria for progress to greater levels of independence with a view to identifying LHGs which will be ready to take direct responsibility for commissioning a range of agreed services from April 2000, ' it says.

Tony Calland, chair of the Welsh GP committee, said this approach would allow the Welsh assembly to influence the development of LHGs and was generally welcomed by GPs.

'It will allow GPs to show HAs they are mature enough and competent enough to take on a minor HA role, ' he added.

The guidance says LHG management boards will consist of an executive committee, 'normally' headed by a GP chair.

They will include two HA representatives, two local authority officers and other stakeholders.

The inclusion of local authority officers, rather than elected representatives, has been generally welcomed as reducing the influence of local politics on the new organisations.

An HA official will become the 'responsible officer' for each LHG, answering to the HA chief executive and with 'a duty of support' to the LHG chair.

Funds will be allocated to LHGs by HAs, using the same formula as the Welsh Office uses to determine HA allocations.

The guidance says the new structure 'will not affect GPs' ability to fulfil their terms of service obligation always to prescribe and refer in the best interests of patients'.

But it also says LHGs will be 'expected to live within their budgets' and overspends will be managed 'within the funds available to HAs' so 'the effect of one LHG overspending will be to reduce the resource available to other LHGs in the area'.

There is no indication that the substantial deficits incurred by some Welsh HAs will be written off before the new system goes live next year.

Establishing Local Health Groups . Welsh Office. Crown Building, Cathays Park, Cardiff CF1 3NQ. Free.