ABSTRACT

Combining forces people made a joint approach to the commission with a further two experienced fundholding practices from Bath and Frome. The four practices should remain independent with individual budgets but combine for risk and a joint agreement to adhere to the commission's ongoing strategy. The four practices are: Information, Long-term mental health services, Community hospitals and emergency admissions, Maternity and social services. The health authority and Wiltshire Social Services have promoted link workers, housed and active within the practices as part of the primary care team and, from 1996, practice-attached mainstream social workers. Total purchasing means that the practices are acting as agents of the health authority and so within the authorities ongoing agreed strategic framework. The accountability and monitoring processes follow the accepted fund-holding framework, incorporated with the authority's business planning cycle. The commission holds no reserve to deal with our overspending, so monitoring must be early.