title: Changes in patient satisfaction and experience in primary and secondary care: the effect of general practice fundholding.
abstract: BACKGROUND
  The contributions of patients' opinions to the evaluation of health care is widely acknowledged. This study investigates whether the patients of a fundholding practice perceived any changes in the services offered.
  
  
  OBJECTIVE
  To examine the effect of general practice fundholding on patient satisfaction with both primary and secondary care services.
  
  
  METHODS
  In April 1992, questionnaires were sent to 180 patients in each of four second-wave fundholding practices and four non-fundholding practices in the former South East Thames region. This took place before any changes were made in the practices as a result of fundholding. Repeat questionnaires were sent 30 months later.
  
  
  RESULTS
  The overall response rate was 70% in 1992 and 66% in 1994/1995. Satisfaction levels were generally high for primary care services and changed little over time. There was no evidence to suggest that fundholding GPs were less inclined to prescribe or refer to secondary care services. Waiting times for the first appointment with a consultant in secondary care had reduced between 1992 and 1994 for patients referred from the fundholding practices. However, there were no differences in the time patients had to wait for subsequent treatments or further investigations. One-fifth of the fundholding patients referred to secondary care were seen by the specialist in their doctor's surgery, and those seen in this setting preferred it.
  
  
  CONCLUSIONS
  Patients perceived no major differences in primary care services over the period between the two surveys. There was some evidence of preferential treatment for patients of fundholding practices, but only in waiting times for the first appointment with the secondary care specialist.
authors.affiliation: University of Greenwich, London.
authors.forename: R H
authors.initials: RH
authors.lastname: Corney
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D005260:Female; D005381:Financing, Organized; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011216:Practice Management, Medical