Effect of NHS reforms on general practitioners' referral patterns.
OBJECTIVE
To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the implementation of the NHS reforms in April 1991.


METHODS
Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and March 1992 and detailed comparison of two time periods: October 1990 to March 1991 (phase 1) and October 1991 to March 1992 (phase 2).


METHODS
10 fundholding practices and six non-fundholding practices in the Oxford region.


METHODS
Patients referred to consultant outpatient clinics.


RESULTS
After implementation of the NHS reforms there was no change in the proportion of referrals from the two groups of practices which crossed district boundaries. Both groups of practices increased their referral rates in phase 2 of the study, the fundholders from 107.3 per 1000 patients per annum (95% confidence interval 106 to 109) to 111.4 (110 to 113) and the non-fundholders from 95.0 (93 to 97) to 112.0 (110 to 114). In phase 2 there was no difference in overall standardised referral rates between fundholders and non-fundholders. Just over 20% of referrals went to private clinics in phase 1. By phase 2 this proportion had reduced by 2.2% (1.0% to 3.4%) among the fundholders and by 2.7% (1.2% to 4.2%) among the non-fundholders.


CONCLUSIONS
Referral patterns among fundholders and non-fundholders were strikingly similar after the implementation of the NHS reforms. There was no evidence that fundholding was encouraging a shift from specialist to general practice care or that budgetary pressures were affecting general practitioners' referral behaviour.
Coulter
A
A
Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary.
Bradlow
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000191:economics*; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization; D013222:State Medicine; D006113:United Kingdom