In April, primary care groups - still talking shops without secretariats - will 'go live', setting pro and anti-fundholders together, in an attempt at enforcing unifying policies among GPs of diverse opinion. Similarly, nurses, health visitors, social workers and political appointees will be plunged into the melting pot, the inevitable result of which will be a political goulash.

A major criticism of fundholding was the possible disparity of services between adjacent practices. This dichotomy is now to be perpetuated in law among some 100 PCGs nationwide, which are expected to provide 'a third way' without the help of a blueprint.

In the last six months we have become aware of many health authority managers, eager to maintain their positions, playing musical chairs while applying for their own jobs; we must assume this tail-chasing exercise will continue for the foreseeable future, and result in an uneasy status quo with no real development.

A chancellor who, in the current worldwide economic slump, predicts national economic growth of 2 per cent may be rightly afforded the title of director of porcine aviation. But if in reality economic growth remains at 0 per cent, what options will he have but to increase taxes or reduce funding? In effect, the 'R' word will have become part of New Labour's policy. Are primary care staff meant to deliver this rationing of services?

Historically, few health reforms have been introduced without a little oiling of the wheels, and yet - at a time of particularly low morale, when the percentage of GPs over 60 has dropped and recruitment into primary care is at an all-time low - we are asked to embrace a concept of Soviet proportions, which may have idealistic advantages but which, in real terms, will kill innovation and allow antagonists of fundholding a sweet - if politically motivated - revenge. We wish New Labour all success in trying to put the genie back in the bottle.

In accepting the inevitable, however, the GP must confront the present debacle with resolve and, much more importantly, accept that as the biggest employer in Europe, the NHS is a business - altruistic by nature, but still a business.

So is it really acceptable to expect a highly qualified midwife at the top of the pay scale, for example, to take on the responsibilities of home delivery day after day for the princely sum of£23,000 per year?

Be reasonable. Management, and all that it entails, is key to all health reforms, and in particular, paying a professional body a reasonable wage, accepting that this will cost in the short term but that in the long term the rewards will follow.

Dr David Pelta

Southend