Taking equity seriously: A dilemma for government from allocating resources to primary care groups

General practitioner fundholding seemed to threaten equity of access to health care in the NHS in two ways: fundholders' patients have been treated more quickly than patients from non-fundholding practices in the same authority,1 2 3 and there are suspicions that fundholders have been funded more generously than have health authorities, who supply funds to non-fundholders.3 4 5 6 The new Labour government has now announced its intention of abolishing fundholding and has introduced policies that are intended to remedy both types of inequity.2 7 8 Because of endemic variations in medical practice, however, this is not possible—leaving the government on the horns of a dilemma over which type of equity it intends to achieve. It will have to choose either common waiting times or an equitable allocation of resources, and these choices have quite different policy implications. The NHS was created with the objective of reducing inequity,9 10 but this raises questions over which type of equity is being sought.11 The NHS reforms introduced two types of local insurers: general practitioner fundholders and health authorities.12 Fundholding seems to compromise two different types of equity: clinical equity, which is achieved when clinicians use only grounds of clinical priority to decide when patients are to be treated, and financial equity, which is achieved when local insurers within the NHS are allocated equal resources per capita, taking account of the relative risk of their populations. #### Summary points