Partnerships in purchasing: development of consortium-based purchasing among GP fundholders

In the last few years there have been considerable changes in the National Health Service (NHS) in the UK. Arguably the most significant of these has been the introduction of competition. Central to this development has been the introduction of general practice (GP) fundholding, whereby practices purchase health care for their patients directly from competing suppliers. Those practices which have become fundholders have faced considerable challenges in developing their purchasing function, given the complexities of contracting within the context of the NHS internal market. Although one of the original aims of GP fundholding was to facilitate locally responsive purchasing, such have been the complexities of contracting that many fundholding practices have attempted to reduce the managerial demands of purchasing through membership of purchasing consortia. Based on an in-depth study of GP fundholders across Scotland, this paper explores the development of consortium-based purchasing. Specifically, this paper seeks to address three issues central to the evolution of such consortium-based purchasing. Firstly, the patterns of organizational structure and the operational dynamics of such consortia. Secondly, the impact of such consortia on the process of fundholder purchasing. Thirdly, the managerial implications of purchasing through such consortia for the participating practices. In addressing these issues, it will examine whether such patterns of purchaser development have impacted on the evolution of locally responsive purchasing.