GP Fundholding Research Articles

A commentary: Measuring the health economics of depression

AbstractThe perspective of a health economic analysis is vital and this is particularly true in the current debate on the economic analysis of Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic Antidepressants (TCAs). The perspective can be institutional, from central government, region, health commission to GP fundholder, and it can be by cost type: including drug costs alone in the analysis; other direct costs such as GPs' and counselling time; and indirect costs such as loss of earnings due to depression. Economic analysts, who focus on drug costs alone tend to favour TCAs over SSRIs. Those who cast their cost net wider tend to favour SSRIs over TCAs. Future research should concentrate on the ‘invisible costs’ that exist in the prescribing process; and on quality of life and health outcomes to establish treatment cost/successful outcome. This could form an intergral part in the development of future cost effective guidelines for depression.

Framework launched for GP fundholding BMA publishes code on hepatitis B NHS trust boards are on Nolan agenda GPs organise commissioning conference

# Framework launched for GP fundholding {#article-title-2} A new accountability framework has been launched for general practice fundholding. It identifies four main areas of fundholders' responsibilities—management accountability, accountability to patients and the wider public, financial accountability, and professional accountability. Under management accountability it is proposed that practices should set out in an annual plan how it proposes to use the fund and management allowances and submit the plan to the health authority for approval. Fundholders should announce major shifts in their purchasing intentions; should submit a brief annual report to the health authority setting out performance against plan; and should hold regular meetings with the health authority. To make them more accountable to the public fundholders are expected to publish key documents such as annual practice plans and primary health care charters and send them to the community health council as well as making them available for consultation by patients. There should be appropriate …

Market Mechanisms and the Management of Health Care

Examines recent reforms of the UK′s National Health Service (NHS), and explores the pressures for change in the pursuit of an efficient NHS and the conflicts which this causes in an organization which was based on the aim of equity. In particular, addresses the “false revolutions” of managerial change introduced after the Griffiths Report (1983) and the accounting changes introduced in the wake of the Griffiths proposals. Evidence shows that these intended revolutions were limited in impact. The result of these failures has been the introduction of the “real revolution” – the internal market in health care. This is a radical change in both the NHS management arrangements and in service delivery, with the division of the NHS into purchasers (health authorities and GP fund holders) and providers (hospital and community services, whether provided by private, voluntary or state‐owned facilities).

GP fundholding schemes expanding in the UK.

GP fundholding schemes expanding in the UK.

First eight ‘prescribing’ sites in GP fundholders

First eight ‘prescribing’ sites in GP fundholders

Nurse prescribing biased to help fundholders only.

Labour MP Tessa Jowell has accused the Government of using nurse prescribing as a ploy to promote GP fundholding.

NHS Executive plans to encourage GP fundholding

The NHS Executive has announced that it is to review the support available to fundholding general practices. The health minister, Dr Brian Mawhinney, said that the review would be carried out over the next few months and would examine among other things the rules governing the use of savings: “For example, should it be possible to spend savings on patient care outside the scope of fundholding or, as the National Association of Fundholding Practices has suggested, on clinical audit, training, or research? And if we enable fundholders to spend savings on …

Waiting lists in the post-review NHS.

Waiting lists for hospital inpatient treatment have existed since the foundation of the NHS. There have been many theories put forward to explain them and a wide range of proposals have been advanced to reduce or eliminate them. The effect of the recent changes in the NHS, coupled with the renewed political focus on waiting lists, is explored. It is concluded that access to waiting lists may be restricted, either by explicit rationing or as a result of contractual specifications. Further, the introduction of GP Fundholding, together with the purchaser-provider split, could result in a two-tier service, at least for non-urgent patients. These conclusions are illustrated by the findings from a simple simulation model.

Contracting out

Sue Machell argues that the first year of contracting out nursing services to GP fundholders has been a success

Purchasing decisions should reflect nursing quality.

GP fundholders should base hospital purchasing decisions on the quality of nursing care on offer rather than on the length of the hospital's waiting list, Royal College of Nursing General Secretary Christine Hancock told the conference.

Community Mental Health Centres: Challenges to the new orthodoxy

CMHC/Ts have become a commonplace component of mental health service design in the UK. After a short resume of the background to the creation of CMHCs and their record to date, the paper argues that GP fundholding and care management contain challenges to the CMHC/T model that may undermine the preeminence of the model in community mental health services.

Anger over priority to GP fundholders

Anger over priority to GP fundholders

More than £25m ‘wasted by GP fundholders’

More than £25m ‘wasted by GP fundholders’

GP fundholding and psychiatric practice

GP fundholding and psychiatric practice

The Politics of Purchasing in the National Health Service

With the 1992 NHS reforms and the introduction of the internal market a new political game has begun where, for the first time, the rationing of the supply of health care to make it fit unlimited demand is the explicit responsibility of purchasing agents (DHAs, FHSAs and GP Fundholders). This paper analyses the inherent clash between purchaser rationing and traditional NHS values, the unbridled pluralism of the gameplay surrounding the purchaser function, and the absence of accepted rules and procedures. It concludes by reviewing the implication of the reforms for the distribution of power in the NHS.

The Future of Waiting Lists

Waiting lists have been a cause of concern since the inception of the NHS. Many theories have been put forward to explain their existence and there have been many proposals to reduce their length. With the current changes in the NHS and the introduction of the Patient′s Charter has come a renewed emphasis on reducing waiting lists and waiting times. However, analysis of incentives within the new system suggests that waiting lists may be reduced by limiting access rather than by increasing treatment rate. Further, not only GP Fundholding, but also the contractual relationships between District Health Authorities and hospitals may lead to two‐tier systems, with admission priorities based on source of funding rather than clinical urgency. Overall, it is concluded that the NHS Review may result in fewer people obtaining treatment, but with shorter waits for those who do receive treatment.

General practitioner fundholding and psychiatric practice

This is a personal view on the implications for mental health services of the Executive Letter of the National Health Service Management Executive (NHSME), published in July 1992 (EL (92) 48): ‘Guidance on the extension of the Hospital and Community Health Services elements of the GP Fundholding Scheme from 1st April, 1993’.

GP practice expelled after overspending.

The expulsion of a Sheffield practice from the GP fundholding scheme for failing to manage its budget could be the first of many, a nursing union has warned.

GP fundholding status withdrawn

GP fundholding status withdrawn

Contract commitment on Code needed

Districts and GP fundholders should ensure provider units demonstrate their commitment to the UK Central Council's Code of Professional Conduct before they draw up contracts for treatment, new standards on contracting say.