Education And Debate

The New NHS: The Third Year Fundholding: a two tier system?

BMJ 1994; 309 doi: (Published 06 August 1994) Cite this as: BMJ 1994;309:396
  1. J Bain
  1. Tayside Centre for General Practice, Westgate Health Centre, Dundee DD2 4AD.

    The Calverton practice is one of 30 fundholding practices in Nottinghamshire. Three years after the inception of fundholding, it has achieved a lower outpatient waiting time for its specialist clinics than non- fundholding practices in the region. Its district nursing and health visiting services have been strengthened. Prescribing costs remain below the national average, and making further cost reductions has not been easy. The business plan has allowed the practice to work within a defined budget and develop expertise in the purchasing of services. Through the provision of specialist clinics and increased patient demand the workload of general practitioners has risen by 15% in the past year. But fundholding is still a minority activity in Nottinghamshire - a nonfundholders' group has been set up to ensure that purchasing of good quality secondary care is equitably distributed among all patients, and this group is extremely active.

    In 1990 the Calverton practice became one of the first wave fundholding practices in England, with the intention of gaining control over patient care services to offset the shackles of a new contract that was seen as restricting opportunities for change. There are now 30 fundholding practices in Nottinghamshire, which represent 15% of practices, and 23% of the population is now attached to fundholding practices. The Calverton practice has a stable population of 9250 patients, and there are now four partners, two part time assistants, and a vocational trainee. Previous visits to the practice provided information about plans for creating new services, many of which were in the early stages of development. Three years after the inception of fundholding, in spring this year, I revisited the practice and reviewed progress.

    Specialist services to patients

    For many years the general practitioners in the Calverton practice were frustrated by their inability to have any influence on long waiting times and lack …

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