What do we know about fundholding in general practice?

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Abstract
#### Key messages If the general practice fundholding scheme was an afterthought in 1989, it is now at the forefront of the NHS reforms.1 2 Many practices have joined, covering just over 40% of the population and controlling around 8% of the NHS budget for hospital and community health services. The scheme is evolving from one with large numbers of go it alone fundholding practices towards “multifunds” and the 60 new total purchasing pilot schemes. And at the end of last year the NHS Executive heralded a new closer relationship between health authorities and fundholders, in which health authorities should share information on purchasing and begin to monitor and regulate fundholders.3 But as fundholding evolves there is a blip on the horizon—the next general election. While decisions on the future of fundholding will be based on a mix of politics and evidence, the time is overdue to review the evidence on the impact of the scheme to date. We review the main published evidence on efficiency, equity, organisational change, patient choice, and quality of care. ### The scheme The twin aims of introducing fundholding were to promote better value for money and to improve consumer choice.4 Individual or groups of practices with a registered population of over 5000 can opt to hold a budget to pay for specific hospital care; drugs; staffing in the practice; and community services—so called standard fundholding.5 Practices with more than …