International Journal of Epidemiology, Vol 24, S113-S118, Copyright © 1995 by International Epidemiological Association
MF D'Souza
The UK health reforms, among other things, have allowed some family
practitioners ('fundholders') to control part of the budget used to
purchase secondary care for the patients registered with their practices.
Some feared that this change in organization might threaten the equity of
the National Health Service (NHS) by giving advantages to the patients of
fundholding general practitioners (GPs). This has led to the formation of
the first large GP 'Multifund' in the UK. Whilst the first small
fundholding co-operatives were conceived simply as a way of improving the
business efficiency of ordinary fundholding, the much larger Kingston and
Richmond (K&R) Multifund is a professional co- operative of fundholding
family practitioners who share a common management allowance, which
controls pounds 32.6 million per annum, about 20% of the public funds
devoted to health care in its locality, and has a broader agenda. It sets
out to end any two-tier system discriminating between the patients of
fundholding and other practitioners within a locality by making it possible
for all GPs to become fundholders within an open, democratic doctors'
co-operative. Its declared aims are to maintain equity and clinical
integrity, to plan health care and to undertake scientific evaluation. Its
overall goal is to preserve and improve upon the economic and ethical
success of the British NHS. A brief evaluation is included which suggests
that Multifund members believe their organization is currently meeting most
of these aims. The essay argues for GP-led Multifund systems centred on
outcome evidence.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The Multifund and outcome research
Unit of General Practice NHLI, Kingston-upon-Thames, Surrey, UK.
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