The problems of fundholding

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7042.1311 (Published 25 May 1996) Cite this as: BMJ 1996;312:1311
  1. Sarah Stewart-Brown,
  2. Stephen Gillam,
  3. Tony Jewell
  1. Director Health Services Research Unit, University of Oxford
  2. Consultant in primary care Bedfordshire Health Authority
  3. Acting director of public health North West Anglia Health Authority

    Some benefits to patients but no effect on how doctors practice

    General practitioner fundholding is not the unqualified success that the British government would have us believe. That is the verdict of Britain's Audit Commission, which has recently reported the results of a major investigation into fundholding.1 A research team from the commission surveyed all known fund and practice managers in 1994-5 and one in five fundholders in 1995-6. They also surveyed some of the larger non-fundholding practices. They analysed financial returns and audited fundholders' accounts. They searched the literature for studies related to fundholding. They made site visits to a large number of fundholding practices, family health services authorities, district health authorities, and trusts to collect qualitative data.

    The report confirms the success of fundholding in reducing waiting times and outpatient follow up visits. Many fundholding practices report better communication with hospital services, more “primary care friendly” pathology and radiology services, and the development of practice based services for physiotherapy, dietetics, chiropody, psychiatric nursing, and psychology. Many fundholding practices made savings on their drugs budgets in their first fundholding year, but the effect was not maintained. Although fundholders generally spent less on drugs than non-fundholders, these differences may have predated fundholding.

    The report does not present the material that …

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