How general practice is funded in the United Kingdom

Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh, Scotland, UK. David P Weller, FRACGP, MPH, PhD, Professor of General Practice. Department of Health Sciences, University of York, York, UK. Alan Maynard, DSc, FAMS, MFPHM, Professor of Health Economics. David Weller holds the James Mackenzie Chair of General Practice at the University of Edinburgh. His fields of expertise include health services research and cancer, and he currently leads primary care research within the Department of Health’s National Cancer Research Institute. He has worked in clinical general practice in the UK and Australia, and sits on a number of cancer advisory committees for the Scottish Executive and the Department of Health. Alan Maynard was Founding Director of the Centre for Health Economics at the University of York (1983–1995) and has been involved in NHS management since 1983. Since 1997, he has been Chairman of York Hospitals NHS Trust. He was an architect of GP fundholding in the 1980s and has written extensively on primary care issues. He has worked as a consultant for the World Bank, World Health Organization and the European Union in countries such as China, Malawi, Brazil and Thailand. He is an Adjunct Professor at the Centre for Health Economics Research and Evaluation, University of Technology, Sydney. Reprints will not be available from the authors. Correspondence: Professor D P Weller, Division of Community Health Sciences: General Practice Section, University of Edinburgh, 20 West Richmond St, Edinburgh, Scotland EH8 9DX, UK. david.weller@ed.ac.uk The Medical Journal of Australia ISSN: 0025729X 19 July 2004 181 2 109-110 ©The Medical Journal of Australia 2004 www.mja.com.au GP Funding – Viewpoints saw it as a basis for partnerships with the priva fragmentation of the healthcare service. Others s reduced non-emergency medical admissions. Fundholding grew from the Thatcher governm held belief that mark ts are the best way to achiev healthcare. At the same time, fundholding establ he m pr T National Health Service (NHS) has undergone fundaental reform since 1948, but the fabric of UK general actice remains more or less intact. Fundholding was probably the most significant change in financial arrangements (Box). Essentially, this was an experiment for the NHS to contain costs, stimulate competition and bring resource allocation decisions closer to the patient — fundholding general practitioners assumed significant roles in local healthcare economies. Nevertheless, there was much debate over whether it was equitable. Many te sector and howed that it