What is total purchasing?

Abstract

“Total purchasing” by general practitioners who have been delegated a budget by their local health authority to purchase potentially all the hospital and community health services for their patients is the latest and most ambitious extension of the concept of general practitioner fundholding. Several pilots have been established to test the concept, and a national evaluation has been assessing the costs and benefits attributable to total purchasing. We present here a summary description of the English and Scottish total purchasing pilot projects based on the preliminary report of the national evaluation.1 Evaluative data are not yet available on the consequences of the pilot projects. General practitioner fundholding was introduced into the National Health Service (NHS) as part of the Working for Patients reforms of 1991.2 Under this scheme volunteer general practices are allocated budgets to purchase a restricted range of services for their patients, predominantly elective hospital procedures and community health services. From an early stage, however, several general practitioner fundholders were interested in extending the concept to a wider range of services. Four “pioneer” total purchasing pilot projects began in 1994 with regional support in Bromsgrove, Runcorn, Berkshire, and Worth Valley, West Yorkshire. The idea behind these local projects was rapidly taken up by the NHS Executive, which in October 1994 invited bids to establish a first wave of total purchasing pilot projects in England and Scotland to start their preparations for total purchasing in April 1995.3 The pilots were to start live purchasing in April 1996 and run until April 1998. Unlike fundholding, and in line with their status as pilots, they were all to be evaluated “to identify the most appropriate models.” Fifty three first wave national projects began in England and Scotland in April 1995 and were joined by 35 second wave projects …