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Most of Scotland's GPs plan to join local healthcare co-operatives. But those in remote areas are less keen, and the Isle of Skye is opting out completely, reports Barbara Millar

Fundholding never really got off the ground in Scotland. But while the early signs are that the present government's plan for local healthcare co-operatives is proving more successful at recruiting GPs, is it popular?

Though the scheme is voluntary - unlike primary care groups in England and Wales - the Scottish Office suggests it is on target to sign up 95 per cent of practices. And in many parts of the country 100 per cent have already said they want to join.

But Dr Chris Tiarks, deputy chair of the British Medical Association's Scottish GP committee, says the number of practices signing up to the co-operatives does not reflect the feelings of those taking part.

'People are forming co-ops because that is all they have been given,' he says. 'Although it is voluntary in name, doctors feel that unless they pick up these new tools they will lose even more control over their destiny.'

On the whole, the reaction to the co-operatives is 'muted apathy', says Dr Tiarks and, he adds, given that GPs in rural and remote areas will find it hard to participate, the idea that they will promote equity of access to services is wrong.

'One two-tier system is now being replaced by another,' he says.

Not everyone agrees. 'We expect all practices to sign up,' says a spokesperson for co-operatives in the Forth Valley health board area. 'We have not heard of any reluctance by GPs to join.'

'No dissension has been indicated to us,' adds a spokesperson for Lomond and Argyll primary care trust, which has two co-operatives in its area.

'We are enthused by the amount of interest shown and are not aware of anyone going to the barricades over it. Our expectation is that all GPs will be signed up to one.'

In Fife there is 'almost 100 per cent coverage', says Dunfermline local healthcare co-operative chair Alan McGovern. In Dunfermline six group practices have signed up, although the seventh remains 'agnostic', he says.

'That practice has some philosophical difficulties with having to assume a wider responsibility for prescribing and public health issues. But they are still interested in the idea and are continuing to debate the matter internally.

'I believe they will join later this year,' he adds.

It is one of a small number of pockets of resistance up and down the country. Elsewhere, more than 90 per cent of GPs in Tayside have signed up.

But some fear the unity of general practice may not be maintained and they don't want to be involved in the potential fall-out, adds Brian Smyth, project manager for Dundee's co-operative.

'Obviously there are varying degrees of enthusiasm among the practices which do want to be involved with the LHCC but they have all agreed to work together.'

Resistance is strongest on the Isle of Skye, where doctors have decided against forming a co-operative at all, largely because of the difficulties in finding locum cover. Initially, doctors there believed there was little benefit in developing a co-operative.

'But a meeting with senior executives from the primary care trust, at which they encouraged us to consider prescribing rationalisation, with any savings made channelled back into the LHCC, has made people think more positively about the idea,' says Skye GP and Highland local medical committee representative Dr Charles Crichton.

But the practical problems remain. Dr Crichton says: 'We have only two realistically useful locums on Skye. If the five practices on the island needed to get together for meetings or even to have a teleconference, the bodies aren't there to allow them to do so.'

The Skye doctors' reluctance to embrace co-operatives is not 'a knee- jerk reaction', Dr Crichton adds. 'Rather we acknowledge the good aspects and believe the positive areas of the reforms - such as clinical governance - should be happening anyway.'

Dennis Tracey, medical director of Highland PCT, says although rural GPs there have practical problems, 'there will probably be 10 LHCCs covering 95 per cent of GP practices at the end of the day'.

He says: 'People recognise that this is a new animal and they would benefit from forming into these groups.

'I wouldn't say there was wild enthusiasm but more of a suck-it-and-see feeling.'

Doctors in Ayrshire are signing up although they see the co-operative scheme as 'a new set of hoops which have to be jumped through', says Stevenston GP Dr Huntly McCallum.

'There are some advantages but the incentives were a lot better with fundholding.'

Some practices in Stevenston, Ardrossan and Saltcoats have not signed up to join a co-operative 'because they have a difficulty with some of the aspects of the new arrangements, such as sharing information', says Dr McCallum.

'We are trying to encourage them to join but the fact that we will all need to know a great deal more about each other's business, in order to operate effectively, puts them off. GPs are still pretty


Practices in more deprived parts of the towns have been keener to join up.

'The practices which are not playing ball are in relatively less deprived areas. I don't know whether they see this issue as an additional problem.'