Editorials Making it universal raises some difficult issues

The future of locality commissioning

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7089.1212 (Published 26 April 1997) Cite this as: BMJ 1997;314:1212
  1. Nicholas Mays, Director of Health Services Researcha
  1. a Policy Institute, King's Fund, London W1M 0AN

    GP fundholding was introduced by the Conservative government to involve general practitioners in shaping local health services1: individual practices acted as agents for their patients, using their own budgets to bring about quality and efficiency improvements in hospital and community health services. A range of alternative, unofficial schemes has emerged at local level (non-fundholding, general practitioner led commissioning, and locality commissioning2 3 4) led by non-fundholders who want to help shape local health services but are sceptical about holding an individual practice budget. These schemes have received less attention than fundholding and its derivatives,5 6 but this issue of the BMJ includes a rare attempt to evaluate locality commissioning in Avon, where there seem to be modest benefits at a much lower cost than …

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