Fundholding in the south Thames Region

Area of Science:

• Healthcare Management
• Primary Care Policy
• Health Economics

Background:

• The National Health Service (NHS) implemented general practice fundholding as a key reform to enhance service efficiency.
• This initiative aimed to increase general practitioners' awareness of the financial implications of their clinical decisions.
• Concerns were raised regarding potential adverse effects of the fundholding scheme.

Purpose of the Study:

• To monitor changes in fundholding and non-fundholding general practices from 1992 to 1995.
• To assess the provision of care nearer to patients and the mixed economy of care.
• To evaluate the efficiency, costs, and commitment associated with fundholding practices.

Main Methods:

• A study involving 15 first-wave, 4 second-wave fundholding, and 4 non-fundholding general practices.
• Data collection through interviews, questionnaires, prescribing data analysis, and financial accounts.
• Analysis of income and expenditure for fundholders.

Main Results:

• Establishment of consultant and paramedical outreach clinics in fundholding practices.
• Fundholders demonstrated lower overall prescribing costs compared to non-fundholders.
• A significant rise (approximately one-third) in overall prescribing costs across all practice groups over three years.

Conclusions:

• Outreach clinics may fragment services despite addressing common conditions.
• The role of non-NHS employees in primary care requires careful consideration.
• Fundholding integrates purchasing and in-house development, presenting a complex challenge for general practice roles.