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Majority of GPs ‘disenchanted’ with reforms

Fundholding is producing genuine innovation in only a minority of practices which have joined the scheme, research from Nottingham University reveals.

Only two fifths of fundholding GPs are pursuing innovations in the way they run their practices, compared with about a fifth of non-fundholders. Just as many fundholders are disenchanted with the NHS reforms.

David Whynes, the health economist who carried out the research, concludes that ‘a majority of GPs are disenchanted with the changes and see them as constraining what they can do rather than empowering them on behalf of patients’.

‘The reforms have been more successful in promoting efficiency savings than in generating genuine innovations in the way primary care services are run.’

Mr Whynes believes that the findings raise the question of whether it is necessary to undertake wholesale reorganisation of the NHS in order to promote innovation in primary care.

Meanwhile, a review of the London Initiative Zone primary care development programme by the King’s Fund argues that evaluation of the scheme has been inadequate. LIZ projects were set up so rapidly in 1993 that proper evaluation was neglected.

‘As a result, it is very difficult to assess the impact of the programme, which cost over £200m in three years’, according to the Fund.

However, the progess of the 53 national total purchasing pilot projects, in which responsibility for additional purchasing is devolved from health authorities to groups of practices, is being carefully monitored by the Fund.

In an interim report on the first year’s experience, the King’s Fund team has found wide variation in the experiences of the different sites. Budget-setting was a ‘major difficulty’ at many sites, along with the extra administrative workload imposed on GPs.The direct management costs of setting up and running the projects in the preparatory year was as high as £300,000 in some sites.

Total purchasing: a profile of national pilot projects. From BEBC: 0800 262260.