Efficiency of care at the primary-secondary interface: variations with GP fundholding

The aim of the study was to investigate the processes of referral for out-patients care and the interface with general practice, from the perspective of the patient, the patient's general practitioner and hospital specialist. The analyses reported here present variations with fundholding and non-fundholding general practice. The design was a questionnaire survey of out-patients, their hospital specialists and general practitioners, in six, randomly sampled district health authorities in the North Thames Region, with stratification by area. The measures included validated items and scales on process, quality and patient satisfaction with services. Fundholders were more likely to have technical equipment and services available within the practice. There were no differences between fundholders and non-fundholders and the number of out-patient attendances made by their patients, hospital out-patient waiting list times, patients' waiting times in hospital clinics, nor in patients' satisfaction with out-patients and other process indicators. Fundholding is currently being replaced with the proposed wider locality commissioning schemes, with GPs, health authorities and other purchasing bodies acting in partnership. Health authority commissioning will be required to reflect the preferences of GPs. Participants in these schemes will need to pay particular attention to the areas where research indicates that fundholding GPs made little difference to increasing the efficiency and effectiveness of health care both in their own practices and at the primary-secondary care interface.