THE EFFECTS OF FUNDHOLDING IN GENERAL-PRACTICE ON PRESCRIBING HABITS 3 YEARS AFTER INTRODUCTION OF THE SCHEME

Objective--To observe changes in prescribing practice that occurred af ter the introduction of fundholding in first wave practices and to con trast these with changes occurring in similar non-fundholding practice s. Design--Prospective observational study. Setting--Oxford region fun dholding study. Subjects--Eight first wave fundholding practices and f ive practices that were not interested in fundholding in 1990-1, which were similar in terms of practice size, training status, locality, an d urban rural mix. Three of the fundholding and none of the non-fundho lding practices were dispensing practices. Main outcome measures--Chan ges in prescribing practice as measured by net cost per prescribing un it, cost per item, number of items prescribed, and substitution rates for generic drugs three years after the introduction of fundholding. D ata for fundholding practices were analysed separately according to wh ether they were dispensing or non-dispensing practices. Results--Presc ribing costs rose by a third or more in all types of practice. The pat terns of change observed in this cohort after one year of fundholding were reversed. No evidence existed that fundholding had controlled pre scribing costs among non-dispensing fundholders; costs among dispensin g fundholders rose least, but the differences were small compared with the overall increase in costs. Conclusions--Early reports of the effe ctiveness of fundholding in curbing prescribing costs have not been co nfirmed in this longer term study.