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  1. Prospective study of...
  2. Prospective study of trends in referral patterns in fundholding and non-fundholding practices in the Oxford region, 1990-4
General Practice

Prospective study of trends in referral patterns in fundholding and non-fundholding practices in the Oxford region, 1990-4

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7014.1205 (Published 04 November 1995) Cite this as: BMJ 1995;311:1205
  1. Rebecca Surender, research officera,
  2. Jean Bradlow, honorary research associateb,
  3. Angela Coulter, directorc,
  4. Helen Doll, statisticiana,
  5. Sarah Stewart Brown, director
  1. aHealth Services Research Unit, department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
  2. bUnit of Health Care Epidemiology, Department of Public Health and Primary Care, University of Oxford
  3. cKing's Fund Development Centre, London W1M 0AN
  1. Correspondence to: Professor Coulter.
  • Accepted 18 October 1995

Abstract

Objective: To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the NHS reforms in April 1991.

Design: Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and January 1994 and detailed comparisons of three phases--October 1990 to March 1991 (phase 1), October 1991 to March 1992 (phase 2), and October 1993 to January 1994 (phase 3).

Setting: 10 first wave fundholding practices and six non-fundholding practices in the Oxford region.

Subjects: Patients referred to consultant outpatient clinics.

Results: NHS referral rates increased in fundholding practices in phase 2 and phase 3 of the study by 8.1/1000 patients a year (95% confidence interval 5.7 to 10.5), anincrease of 7.5% from phase 1 (107.3/1000) to phase 3 (115.4/1000). Non-fundholders' rates increased significantly, by 25.3/1000 patients (22.5-28.1), an increase of 26.6% from phase 1 (95.0/1000) to phase 3 (120.3/1000). The fundholders' referral rates to private clinics decreased by 8.8%, whereas those from non-fundholding practices increased by 12.2%. The proportion of referrals going outside district boundaries did not change significantly. Three of the four practices entering the third and fourth wave of fundholding increased their referral rates significantly in the year before becoming fundholders.

Conclusions: No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates, although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year. Despite investment in new practice based facilities, no evidence yet exists that fundholdingencourages a shift away from specialist care.

Footnotes

  • Funding Oxford Regional Health Authority

  • Conflict of interest None.

  • Accepted 18 October 1995
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