Kings Fund proposes GP fundholding mark two

10 Jun 04
NHS funds should be devolved to GP practice level to provide more responsive services, the King's Fund said this week.

11 June 2004

NHS funds should be devolved to GP practice level to provide more responsive services, the King's Fund said this week.

Ministers have made much of passing control of 75% of NHS spending to primary care trusts in England and have sanctioned further devolution to practice level. But, in a report published this week, the fund says that the Department of Health should do more to encourage practice-led commissioning.

The move would be controversial because this is similar in many respects to GP fundholding, one of the cornerstones of the Conservatives' NHS market in the 1990s.

Fundholding was not universal and was criticised for creating inequalities. Fundholders were given a cash-limited budget to buy a select number of treatments, allowing some to bypass waiting lists by opting for private care, for example.

Practice-led commissioning: harnessing the power of the primary care frontline acknowledges that practice-led commissioning and fundholding have much in common. But the fund's chief executive, Niall Dickson, said the result would not be the same because the context for the reform had changed.

'Patients in all practices should increasingly be offered choices about where they are treated, which should avoid the earlier concerns about creating a two-tier system,' he said. 'The new market will operate in a different way with fixed prices for all operations, which should remove the potential for individual practices to lever favourable prices from hospitals desperate for extra income.

'All that should go some way to reducing anxiety over potential inequities that in theory could re-emerge if some GP practices were given greater freedoms to commission over others.'

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