Non-fundholding in Nottingham: a vision of the future

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Abstract
The 1991 health service reforms introduced the internal market and gave individual fundholding practices budgets with which they could attempt to secure preferential access to secondary health care for their patients. In the view of many doctors this undermined the principle of equity on which the NHS was founded. In Nottingham 200 non-fundholding general practitioners have joined together to act in liaison with their purchasing health authority. A committed representative group of general practitioners can collectively offer more time and knowledge to the contracting process while minimising the impact on clinical workload. As a large purchaser with low management costs the group has secured access to quality secondary care which is equitably available to all patients, preventing the development of a local two tier service. Nottingham's non- fundholding model of commissioning is equitable and efficient. “Non-fundholding” is an implicity negative term. It suggests undermotivated, uninterested, iconoclastic general practitioners resisting the rising tide of fundholding. Such interpretations fail to appreciate that if viewed as a positive proactive concept non-fundholding transforms into a remarkably powerful force in the developing NHS marketplace. In the past 18 months Nottingham Non-fundholders has successfully promoted non-fundholding as a positive influential choice for general practitioners who wish to obtain equitable access to quality secondary care for their patients while avoiding the bureaucracy and conflicts of interest which arise from fundholding. We describe the principles of our non-fundholding model); how Nottingham Non-fundholders was formed; the history and structure of the organisation; and its aims, achievements, and vision of the future. Contemporary events need to be seen in their historical context if they are to be fully understood. It seems difficult today, with 95% of hospitals having trust status and over 40% of the population covered by fundholding general practitioners, to recall the mood of late spring 1992. At …

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