GP fundholding - the facts
Posted on 27 September 2005
GP fundholding was abolished in 1999 amid concerns that it helped to foster a two-tier health service. This year in an apparent volte face the government reintroduced delegated budgets to individual GP practices under the banner of Practice Based Commissioning.
While Practice Based Commissioning is likely to deliver a number of
valuable benefits for patients and local health economies, there is a
risk the initiative will also induce a range of negative outcomes for
the NHS. This is one of the conclusions of the latest paper in the
University of York's Health Policy Matters series, published in
conjunction with the Dr Foster Ethics Committee. Based on a review of
the latest econometric evidence on the impact of the fundholding
experiment, the paper highlights a number of possible benefits and
drawbacks: Likely benefits include:
- A lowering in elective referral rates to hospitals
- Reduced emergency related occupied hospital bed days
- Shorter waiting times for emergency treatments
- Improved co-ordination of primary, intermediate and community support services
- Better engagement of GPs in the commissioning and developing care integrated pathways
- Likely dis-benefits include:
- Reduced patient satisfaction
- Increased management and transaction costs
- Inhibiting inter-organisational co-ordination and the shared accomplishment of care delivery
The author concludes "Given the need to improve primary care teams
and improve control of hospital demand with practice based
commissioning, the lessons from evaluation of GP fundholding indicate
that incentives will have to be improved and the diversity of
innovation carefully managed and evaluated to ensure that improved
patient benefits and greater efficiency can be secured".
Notes to editors:
- Dr Russell Mannion is a Senior Research Fellow in the Centre for
Health Economics, University of York. The full paper can be accessed electronically and free at http://www.york.ac.uk/healthsciences/pubs/hpmindex.htm
- About the Dr Foster Ethics Committee The Dr Foster
Ethics Committee is a regulatory body independent of Dr Foster, which
has been set up to provide guidance and oversee the work of Dr Foster.
The Ethics Committee is entirely independent of Dr Foster. To ensure
impartiality, members of the committee are not remunerated for their
time, none of the participants have any financial links with Dr Foster
and they have no involvement in Dr Foster's commercial partnerships.
Their interest is purely in ensuring better public access to health
information. To find out more about Dr Foster visit: http://www.drfoster.co.uk
- Health Policy Matters
Department of Health Sciences
Area 2, Seebohm Rowntree Building
University of York, Heslington
York YO10 5DQ
Editor: Professor Alan Maynard
Tel: (01904) 321333
healthpolicymatters@york.ac.uk http://www.york.ac.uk/healthsciences/pubs/hpmindex.htm