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General practice fundholding: progress to date

R D Smith1, P Wilton

  • 1Health Economics Unit, Faculty of Business and Economics, Monash University, West Heidelberg, Victoria, Australia.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|August 6, 1998
PubMed
Summary
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General practice fundholding in the NHS shows mixed results. While some cost savings and procedural quality improvements are noted, evidence on health outcomes and patient choice remains limited.

Area of Science:

  • Health policy analysis
  • Healthcare management
  • Health economics

Background:

  • National Health Service (NHS) reforms established an internal market, separating purchasing and providing roles.
  • General practice fundholding was central to the 'patient-led NHS' initiative.
  • Objectives included improved cost-containment, cost-effectiveness, quality of care, and patient empowerment.

Purpose of the Study:

  • To review evidence on the achievement of NHS reform objectives over six years.
  • To assess the impact of general practice fundholding.

Main Methods:

  • Conducted a keyword search of MEDLINE and Econ-lit databases (1990-1996).
  • Performed a manual search of references from identified articles.

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Main Results:

  • Mixed evidence on cost-containment and cost-effectiveness; some prescribing cost savings, unclear impact on referrals.
  • Improvements in procedural quality of care, but little evidence on health outcomes.
  • Enhanced general practitioner choice of secondary providers, but limited increase in patient choice.

Conclusions:

  • Evidence on general practice fundholding is incomplete and mixed.
  • A significant gap exists regarding the impact on health outcomes.
  • Further research is needed to determine if fundholding improved healthcare efficiency.