General practice fundholding and health care costs

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.139 (Published 19 July 1997) Cite this as: BMJ 1997;315:139

Fundholding is not containing prescribing, referrals, or emergency admissions

  1. Duncan Keeley, General practitionera
  1. a The Health Centre, East Street, Thame, Oxon OX9 3JZ

    Fundholding general practices receive budgets to cover three aspects of patient care: ancillary practice staff, a range of non-emergency hospital services, and prescribing. Savings made on these budgets may be moved between the different components or spent on other ways of enhancing services to patients. One of the objectives of introducing fundholding was to give practices a direct incentive to contain the rise in prescribing costs. The study from Northern Ireland published in this week's BMJ (p 166) provides further evidence of limited success in this objective.1 In their first year of fundholding, practices increased their rate of generic prescribing and reduced the rate of rise in their prescribing costs. After the first year of fundholding, first wave fundholders' prescribing costs increased at the same rate as non-fundholders' costs.

    The availability of prescribing analysis and cost (PACT) data makes prescribing costs the easiest aspect of fundholding to study, but can we relate prescribing costs to the quality of prescribing? And can prescribing costs be meaningfully analysed in isolation from the …

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