Has warned: don't rush to set up primary care groups

Guidance from the NHS Executive, due next week, will also state clearly that HAs must involve GPs and other relevant parties in setting up the groups.

The move comes amid mounting concern that some HAs are forging ahead with plans without proper consultation and may be trying to 'pack' PCGs with their own staff.

Fundholders also fear they may be held back as HAs seek to dominate the PCGs by placing them in the lower levels and in separate groups with non- fundholders.

An NHS Executive spokesman warned HAs not to act in haste. He said: 'We know HAs and GPs are keen to get going. But this is a major change and we want to get it right.

'We want the process to be inclusive. HAs must include GPs, other services and the wider public. There has to be a period of negotiation and consultation. Any moves by HAs to put arrangements in place now are premature.'

An Executive letter setting out broad arrangements for consultation and setting up the groups will be followed by more detailed guidance at the end of March.

Rhidian Morris, chair of the National Association of Fundholding Practices, said many fundholders and practices in total purchasing pilots were worried they would be split into separate PCGs. He said: 'I do not think HAs are acting in a malicious way. They are doing what they think is logical.'

But he urged them to slow down and wait for guidance.

Simon Anderson, a GP in the Stoke fundholding practice in Plymouth, said a group of 10 fundholders locally wanted to work together in one PCG. But the HA would not allow it, he claimed.

Dr Anderson said: 'The fear is we will go backwards rather than forwards because the group will start at below level two. It is not possible for non-fundholders to go in at level three.'

He also claimed that fundholders and fundholding management staff had not been included in talks about the groups.

Adrian Jacobs, locality team leader for Torbay, South and West Devon HA, denied there were any specific proposals yet for Plymouth, saying discussions in the area had not begun.

He said there were arguments about whether it was wise to have all commissioning GPs and fundholders in one PCG, but added: 'It is not a judgement we have made yet.'

Brian Skinner, general manager of Southampton East multifund, claimed there had been a recommendation to the project board looking at the PCG issue that they should all be set up at level two. That would be unacceptable, he said.

But a spokesman for Southampton and South West Hampshire HA said it was proposed that all practices should be ready to enter level two as a minimum by the start date of 1 April 1999.

'We are bringing up the slowest ones rather than stopping the progressive ones,' he said.