Education And Debate

Can there be fair funding for fundholding practices?

BMJ 1994; 308 doi: (Published 19 March 1994) Cite this as: BMJ 1994;308:772
  1. J Dixon
  1. Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
  • Accepted 4 February 1994

Most regional health authorities set budgets for fundholding practices according to the amount of care used by the practice population. This article explains why this funding method can only lead to an inequitable allocation of resources between fundholding and non- fundholding practices. Using the experience of North West Thames region, the efforts made to make funding fairer are discussed. The steps that health authorities could take to investigate and reduce the problem are also outlined. In the absence of a capitation formula for funding fundholding practices, the paper suggests that health authorities should do much more to investigate the amount of money they spend on non-fundholding practices. Regions could develop and use other methods to set budgets rather than rely on activity recorded by practices. Regions and the Department of Health should resolve urgently if and how far the budgets for fundholders should be compensated for increases in provider prices.

Treatment in the national health service has always been a bit of a lottery. Treatment depends on where you live, who you are, and the competence of the health professionals who care for you. The NHS inevitably offers a multitiered service to the population despite striving for equity of access for equal need. But now, nearly three years after the 1991 NHS reforms, evidence is mounting that the general practice fundholding scheme has caused a systematic and explicit two tier service to develop, regardless of need.*RF 1-3* While the evidence for two tierism is still largely anecdotal, critics of the fundholding scheme claim that overgenerous funding of fundholding practices lies at the root of such inequity.

This article examines whether the current method of funding general practice fundholders is fair. Using the experience of North West Thames region - a region with one of the highest proportions of residents covered …

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