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New primary care organisation aims to bridge the fundholding divide

The newly formed National Association of Commissioning General Practices (NACGP) held its first conference at the end of October and attracted widespread interest from GPs, NHS managers and the media. Although the association is only 8 months old, it has already proved influential in affecting how GPs are involved in the equitable commissioning of health care. It is unique in providing a bridge between fundholders and non-fundholders, between GPs and primary care teams, and between general practice and health authorities.

Fundholding allows GPs to hold a budget from which they purchase 30 per cent of the health care needed for their patients. Evidence that fundholding has fostered the emergence of a two tier health service, and that it inevitably rations care from the doctor’s surgery, has meant that it has become the most controversial and divisive element of the government’s health service reforms.

NACGP has emerged from the anti-fundholding movement and has positioned itself as a ‘broad front’ organisation, introducing the concept of GP commissioning into the health care market. The majority of GPs (62 per cent) are still not fundholders, and most GPs — including many current fundholders — remain opposed to the concept of holding a budget at practice level. As a positive reaction to fundholding some GPs have formed ‘commissioning groups’ which seek to influence the purchasing of care by health authorities. Currently, health authorities purchase all care for non-fundholders and 70 per cent of care for fundholders.

At present there are about 70 GP commissioning groups in the UK representing 5,000 GPs, 2,000 practices and 10 million patients. Half of these groups have links with local fundholders. The emergence of close relationships between fundholding and non-fundholding GPs at local level has taken the government by surprise, and is supported by NACGP.

The association has called for commissioning groups to be funded on a par with the support which fundholders receive (£35,000 per practice), and has met DoH officials to discuss funding to enable it to co-ordinate support to commissioning groups and to act as a clearing house for commissioning ideas.

NACGP argues that commissioning groups have succeeded in obtaining equitable deals for all patients, and that GP commissioning is not simply an alternative to fundholding but a different approach to building an integrated health service based on need and led by primary care.