title: Can primary care groups learn how to manage demand from fundholders? A study of fundholders in Nottingham.
abstract: BACKGROUND
  Primary care groups (PCGs) will commission care for their patients and may be increasingly required to manage clearly defined resources. Existing general practice fundholders already operate in this environment, but can PCGs learn from the experience of fundholders in managing demand?
  
  
  OBJECTIVE
  To explore how general practice fundholders manage demand for hospital and community health services, and for prescribing.
  
  
  METHODS
  A general practitioner (GP), and a fundholding manager from each of 26 practices were invited to take part. Questionnaires were developed, with structured and semi-structured components, and piloted in three practices. Interviews were conducted between October 1996 and February 1997 by the same interviewer (MDT).
  
  
  RESULTS
  All practices stated that they were monitoring their waiting lists and giving priority to patients whose problems had become worse, but eight of the 23 GPs felt that they were unable to manage demand. Eight of the 15 fundholders who had developed in-house services actively managed the waiting list for these clinics. All fundholders had identified areas of unmet demand. Widely differing methods for increasing supply to meet demand were identified, and are described. Formularies were used by 12 out of the 23 fundholders. Guidelines were only considered useful by eight of the 23 practices; fundholders from later waves were less likely to find guidelines useful than fundholders from earlier waves (odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0 to 0.96). Private specialist surgery was less likely to be accessed by later wave fundholders using the fund than by early wave fundholders (OR = 0.10; 95% CI = 0.09 to 0.97).
  
  
  CONCLUSIONS
  Fundholders in Nottingham had not developed consistent approaches to managing demand within limited resources. Given the apparent diversity of attitudes and practices, the larger PCGs will require strong support to develop the intended commissioning function.
authors.affiliation: Department of Epidemiology and Public Health, Faculty of Medicine, University of Leicester.
authors.forename: M D
authors.initials: MD
authors.lastname: Tobin
authors.forename: C J
authors.initials: CJ
authors.lastname: Packham
mesh_terms: D005194:Family Practice / Q000191:economics* / Q000458:organization & administration; D015276:Health Care Rationing / Q000191:economics; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000191:economics* / Q000706:statistics & numerical data; D011216:Practice Management, Medical / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D006113:United Kingdom