Experiences of first wave general practice fundholders in South East Thames Regional Health Authority.

BACKGROUND. The purchasing power given to general practitioner fundholders has important longterm implications. AIM. A study was undertaken to investigate the experiences of a group of fundholders. METHOD. All 15 first wave fundholders in South East Thames Regional Health Authority were sent a questionnaire asking about their experiences towards the end of the first year of fundholding. RESULTS. The practices varied considerably in the degree of changes made. Nine had developed consultant outreach clinics in the surgery and four had made major changes in their use of providers. Advantages mentioned by respondents were the outreach consultant clinics, increased practice facilities, increased provider responsiveness, greater direct access and facilities for investigations, reduced waiting times for outpatient appointments, increased computerization and a new awareness of practice and provider activity. A number of difficulties were also mentioned, including provider resistance and time spent on administration. CONCLUSION. It is important to view these changes in the context of other National Health Service and general practice reforms: practice based innovations are not unique to fundholding and other initiatives could have brought about these changes. In addition, developments such as outreach consultant clinics which may benefit the practice still need to be evaluated in terms of cost effectiveness and health outcomes, as well as their impact on services elsewhere.