ABSTRACT
Fundholding has travelled a long distance since the first three hundred practices tentatively stepped out on the journey in April 1991. Many health authorities had no experience of working with general practitioners (GPs) and had no respect for their abilities. Health authorities, fund-holders and total purchasers will all need input from public health. Fundholding had the benefit of taking the money necessary for the service out of the often far too cosy relationships between managers and hospital clinicians and putting it into the hands of community-based fellow professionals who could counter spurious professional claims. Many GPs were saying they wished to be responsible for their staff budgets and their prescribing budgets, but would also wish to be responsible for purchasing community nursing services, diagnostic services and outpatient services. Multifunds are in fact an agent of improving the delivery of primary care, as well as beginning to draw out isolated GPs into a more collaborative framework.
