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General practice fundholding: Delivers what patients want

BMJ 1994; 308 doi: (Published 12 February 1994) Cite this as: BMJ 1994;308:475
  1. T Richardson

    EDITOR, - Steve Iliffe and Ulrich Freudenstein decry the lack of scientific evaluationof fundholding yet offer none themselves.1 The costs of administering fundholding are less than the equivalent costs of managing a district health authority. During any period of transition some costs will be duplicated, but this will be rectified with the forthcoming changes in the configurations of both regional and districthealth authorities.

    The political costs of “fast tracking” are a matter of opinion, perhaps coloured by ideology. My experience as a fundholder is that NHS providers, including consultants, are offering fast tracking to fundholders. We have not requested it specifically. It is surprising that so many specialists object to fast tracking (rather than it being the disadvantaged patients who object) but willingly fast track private patients.

    Where is the evidence that fundholders cannot be ruthless as purchasers? Fundholders may be limited in choice, particularly in rural areas, but it is they who are making the most important changes to the way health care is provided for their patients. Increasinglythey are managing extended services, providing consultant clinics and physiotherapy on site and more counselling. Many are also now developing services such as radiology, ultrasonography, colposcopy, and minor and day case surgery on site.

    Fundholders will act in concert with local health policies but only if those policies have been discussed and are thought to be in the interest of their patients. It is up to district health authorities to include fundholding as well as non-fundholding general practitioners in discussions.

    The changes made by fundholders, with increasing provision of services in the community, facilitate rationalisation (deinstitutionalisation) of the often inefficient secondarycare system. In secondary care too many resources are tied up in underused and duplicatedfixed items such as estates, equipment, and sometimes specialist staff. Patients want quick, efficient, and cost …

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