The Multifund and outcome research

The UK health reforms, among other things, have allowed some family practitioners ('fundholders') to control part of the budget used to purchase secondary care for the patients registered with their practices. Some feared that this change in organization might threaten the equity of the National Health Service (NHS) by giving advantages to the patients of fundholding general practitioners (GPs). This has led to the formation of the first large GP 'Multifund' in the UK. Whilst the first small fundholding co-operatives were conceived simply as a way of improving the business efficiency of ordinary fundholding, the much larger Kingston and Richmond (K&R) Multifund is a professional co-operative of fundholding family practitioners who share a common management allowance, which controls pounds 32.6 million per annum, about 20% of the public funds devoted to health care in its locality, and has a broader agenda. It sets out to end any two-tier system discriminating between the patients of fundholding and other practitioners within a locality by making it possible for all GPs to become fundholders within an open, democratic doctors' co-operative. Its declared aims are to maintain equity and clinical integrity, to plan health care and to undertake scientific evaluation. Its overall goal is to preserve and improve upon the economic and ethical success of the British NHS. A brief evaluation is included which suggests that Multifund members believe their organization is currently meeting most of these aims. The essay argues for GP-led Multifund systems centred on outcome evidence.(ABSTRACT TRUNCATED AT 250 WORDS)