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The ‘primary care-led NHS’ need not be fundholding, say commissioning GPs

The government should recognise the success of alternatives to the GP fundholding scheme, and encourage health authorities to work with all of their local GPs, whether or not they are fundholders, says the National Association of Commissioning GPs (NACGP).

The association, which represents GP commissioning groups nationally, wants to see a range of possible models of GP involvement in healthcare planning established, with evaluation by independent academic bodies.

‘The truth is that fundholding is not widely popular’, NACGP argues. ‘Even after five years of intense promotion and attractive incentives, only about 40 per cent of GPs are fundholders.’

A survey of commissioning groups by the association has found that many GPs have been subject to considerable pressure by their local health authorities to become fundholders. More than one in five groups had been pressured to become fundholders in order to secure funding for commissioning activity, while two fifths were aware of other pressures on local GPs - such as promises of grants or reimbursement for extra staff - to take up fundholding.

Nationally, the NACGP is calling for ‘an end to the disparity in funding arrangements for computers between fundholders and non-fundholders’, which it regards as a personal financial incentive for GPs to become a fundholder.

The association believes that, with the introduction of total purchasing initiatives, fundholding will become similar to the commissioning groups which exist in many parts of the country. But it argues that financial accountability is weaker in the fundholding model.

Commissioning groups - about half of which include or have close links with fundholders - have become a widespread alternative to fundholding over the past three years. Currently, the NACGP holds details of almost 60 groups, representing over 5,000 GPs who provide care for about 11 million people, and knows of at least a further 50 groups.

The achievements of commissioning groups are varied and rival those attributed to fundholding. In north west Bristol, the locality commissioning group has established a primary care epilepsy clinic and improved the primary care of patients with orthopaedic problems. In Nottingham, a group of 200 GPs have negotiated reductions in outpatient waiting times, established community-based physiotherapy and new investment in ENT and ophthalmology services. But they regard the ‘intransigence of government to consider alternative models’ a major barrier to further progress.