Purchasing for all: an alternative to fundholding

Area of Science:

• Health Services Research
• Primary Care Management
• Public Health Policy

Background:

• District health authorities increasingly involve general practitioners (GPs) in purchasing decisions.
• The Hackney General Practitioners' Forum was established to facilitate GP input into health authority purchasing.
• Understanding the effectiveness and representativeness of such forums is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To evaluate the participation and effectiveness of general practitioners in a district health authority's purchasing work.
• To assess the perceptions of GPs and health service managers regarding the Hackney General Practitioners' Forum.
• To determine the extent of GP contribution to quality targets and service developments.

Main Methods:

• A questionnaire study surveyed 131 general practitioners and 33 senior health service managers in Hackney.
• Minutes from 28 meetings of the Hackney General Practitioners' Forum were reviewed.
• The contract between City and Hackney Health Authority and St Bartholomew's NHS Trust was analyzed.

Main Results:

• High response rates were achieved (76% of GPs, 82% of managers).
• Both groups perceived the forum as representative, though managers (92%) were more likely than GPs (74%) to find it effective.
• GPs contributed to 75% of quality targets and 55% of service developments, and successfully advocated for specific service resources.

Conclusions:

• General practitioner forums can be representative and effective in influencing healthcare commissioning.
• Achieving consensus and providing administrative support are key for GP involvement.
• Strengthening the relationship between general practice and public health medicine is recommended.