Tuesday, May 19, 1998 Published at 19:56 GMT 20:56 UK
Your local GP
GPs get paid for their NHS work through a basic allowance
For most people, GPs (General Practitioners) are the first point of contact with the NHS. The family doctor provides the initial diagnosis, gives advice, prescribes any drug treatment and, if necessary, refers the patient to the more specialised services run by large hospitals.
There are more than 34,000 GPs in Britain - the vast majority of them working in local health centres. They carry out about 250 million consultations every year.
Everyone over 16 has the right to choose a GP, but the doctor does not necessarily have to accept that person on to their list of registered patients. If, in an emergency, a patient's own GP is unavailable, any GP in the Family Doctor Service will give treatment and advice.
Funding the service
GPs get paid for their NHS work through a basic allowance. They pick up certain other fees and expenses and get paid for doing out-of-hours work. Doctors can also supplement their income with private consultations.
Until very recently, the Family Doctor Service (or General Medical Services) in England and Wales was managed by 90 Family Health Service Authorities. These FHSAs were also responsible for local dental, pharmaceutical and ophthalmic services. But with the far-reaching reforms of the last Conservative Government, the work of the FHSAs was taken over by Health Authorities (HAs) in England and Wales, Health Boards in Scotland, and Health and Social Services Boards in Northern Ireland.
Under the National Health Service and Community Care Act (1990), GPs could also apply for fundholding status. This gave them greater control over their budgets. Initially, only GPs from larger health centres were allowed to become fundholders, but from April 1996 the scheme was extended to cover practices of all sizes.
Fairness in the system
By the time the new Labour Government was ready to introduce its own reforms, 50% of GPs had become fundholders, covering around 60% of the population.
Labour disliked fundholding because, in its view, it allowed the doctors to use their financial independence to negotiate a better deal for their patients over those outside the scheme. The accusation was made that certain patients got seen quicker at hospitals that had a contract with a GP fundholder.
Labour is proposing to abolish GP fundholding and introduce a system of "local commissioning". It wants GPs to band together in primary care groups to commission healthcare from hospitals and other providers. The groups, of about 50 GPs each, will have a budget to buy the health care they think necessary for an area containing 50,000 to 150,000 patients. The govenrment has published separate plans for England, Wales, Scotland and Northern Ireland.
Labour is also reviewing the Patient's Charter so that the onus is not solely placed on doctors to provide certain services. The government says patients also have responsibilities to GPs.