The consultation document on the NHS in Northern Ireland keeps debate on its future very much open. Pat Healy reports

GP fundholding looks set to survive one year longer in Northern Ireland than in the rest of the UK - but with long-term plans which could prove more radical than anything on offer elsewhere.

The Northern Ireland Office's vision - set out in Fit for the Future , a consultation document launched last week - differs from the rest of the UK in two ways.

First, it will continue the integrated health and social care arrangements introduced in the province 25 years ago.

And second, the proposals are not written in stone.

Indeed, the document makes it clear that, apart from the basic principles on which change is to be based, everything is up for debate.

That approach has been broadly welcomed. The NHS Confederation, which has all Northern Ireland health boards and trusts in membership, will run a conference there in June as part of the consultation process.

The new health and personal social services system will be based on principles of equity, the promotion of health and well-being, quality, a local focus, partnership, efficiency, openness and accountability.

The internal market will go, but GP fundholding will continue until 1 April 2000 to allow for 'an orderly transition' to the new arrangements. Unified budgets for health and social services will be introduced at the same time.

The consultation document offers two models for more effective strategic planning, with commissioning moved to a more local level, based on smaller populations and centred on primary care.

Model A is similar to what is happening in the rest of the UK. It would include existing health and social services boards, trusts and new primary care-centred local commissioning bodies.

Local commissioning would be carried out by primary care groups serving populations of between 50,000 and 100,000.

PCGs could develop in various ways, from supporting the boards in their strategic role, to becoming free-standing trusts accountable to boards for commissioning care. The number of boards and trusts would be reviewed.

Model B is more radical. The main element would be new local care agencies which would both commission and provide services, working in partnership with primary care professionals.

Local care agencies would replace both boards and trusts, and cover both acute and community services. There would be six to eight in Northern Ireland, each covering populations of 200,000 to 300,000.

In model B, primary care partnerships, serving 25,000 to 50,000 people, would commission services in line with the local care agency's strategy, and could eventually take on unified, delegated health and social care budgets.

The document says that the agencies would offer an opportunity to streamline the present 19 trusts. One way that could be done would be by creating a single provider organisation within each local care agency.

Alternatively, providers of hospital services could be retained as separate acute organisations, either inside local care agencies or outside them as trusts.

A third option would be to maintain a mixed economy of community-only, hospital-only and integrated providers within local care agencies.

Fit for the Future. Available from 0845-3063030 or on the Internet at or