Global commissioning by general practitionersBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7032.652 (Published 16 March 1996) Cite this as: BMJ 1996;312:652
- Jonathan Shapiro
- Senior fellow Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
Affects attitudes and culture more than service delivery
The purchaser-provider split was introduced to allow “money to follow patients”1 and to move control away from hospital providers towards those making the purchasing decisions. General practitioner referrals were seen as being at the core of those decisions, and general practitioner fundholding aimed to bring the decision making directly into the consulting room. The range of services purchased by fundholders has grown steadily and will cover virtually all elective services from April 1996.2 Conceptually, it makes sense to test the idea of general practitioner purchasing to the limit by applying it to the purchasing of all services, and various models are being explored. Some involve the direct purchasing of secondary care services. Others aspire to more strategic commissioning for larger populations and longer time scales. But all involve general practitioners on the “purchaser” side of the purchaser-provider split. How are these experiments shaping up to evaluation and what can they tell us about the future shape of healthcare in Britain?
Existing models of general practitioner purchasing range from the four current “pioneer” total purchasing projects (in Berkshire, Bromsgrove, Runcorn, and Worth Valley and the 50 or so sites planned for the “second wave” of total purchasing3; through the gamut of different locality projects (exemplified by Newcastle and North Tyneside's …
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