General practice fundholding in the UK National Health Service: evidence to date

Abstract

The published evidence on the effects of General Practitioner Fundholding, a major feature of the 1991 reorganization of the UK National Health Service, is reviewed with regard to the source and character of the evidence, as well as the findings on the outputs (including referrals, prescribing, service shifts, and the attitudes of various actors); the processes (inter- and intra-organizational); and the inputs (costs). An overall assessment based on this evidence is presented; the latest political and organisational developments in NHS primary care are outlined; and the future of GP fundholding is discussed.