ABSTRACT
The disciplines of total purchasing are somewhat different from standard fund-holding as practices are sharing the new part of the budget and will need to consider carefully what arrangements they will come to in the event of over- or underspends. The new part of the budget is controlled by the total purchasing group, acting as a sub-committee of the health authority, who will want to see robust monitoring arrangements in place to ensure financial control and probity. Pooling budgets between several practices makes it more difficult for total purchasing pilots to create incentives for individual general practitioners to change their behaviour. Total purchasing requires a more strategic approach to purchasing than does standard fundholding. Standard fundholders are accountable to the National Health Service (NHS) Executive, through NHS Executive regional offices; although in practice day-to-day accountability is to the local health authority.
