Effect of NHS reforms on general practitioners' referral patterns

Area of Science:

• Health Services Research
• General Practice
• Healthcare Policy

Background:

• The National Health Service (NHS) reforms of April 1991 introduced fundholding, a new purchasing mechanism for general practices.
• Understanding the impact of these reforms on outpatient referral patterns is crucial for evaluating healthcare delivery and resource allocation.

Purpose of the Study:

• To compare outpatient referral patterns between fundholding and non-fundholding general practices.
• To assess changes in referral behavior before and after the implementation of the NHS reforms.

Main Methods:

• Prospective data collection on general practitioners' referrals to specialist outpatient clinics.
• Comparison of referral data from two periods: pre-reform (October 1990-March 1991) and post-reform (October 1991-March 1992).
• Inclusion of 10 fundholding and six non-fundholding practices in the Oxford region.

Main Results:

• No significant change was observed in the proportion of referrals crossing district boundaries between fundholding and non-fundholding practices post-reform.
• Both groups of practices increased their overall referral rates after the reforms.
• No difference in standardized referral rates was found between fundholding and non-fundholding practices in the post-reform period.
• A slight reduction in referrals to private clinics was noted in both practice types after the reforms.

Conclusions:

• Outpatient referral patterns remained similar between fundholding and non-fundholding practices following the NHS reforms.
• There was no evidence that fundholding encouraged a shift towards general practice care.
• Budgetary pressures associated with fundholding did not appear to significantly influence general practitioners' referral behavior.