THE MULTIFUND AND OUTCOME RESEARCH

The UK health reforms, among other things, have allowed some family pr actitioners ('fundholders') to control part of the budget used to purc hase secondary care for the patients registered with their practices. Some feared that this change in organization might threaten the equity of the National Health Service (NHS) by giving advantages to the pati ents of fundholding general practitioners (GPs). This has led to the f ormation of the first large GP 'Multifund' in the UK. Whilst the first small fundholding co-operatives were conceived simply as a way of imp roving the business efficiency of ordinary fundholding, the much large r Kingston and Richmond (KandR) Multifund is a professional co-operati ve of fundholding family practitioners who share a common management a llowance, which controls pound 32.6 million per annum, about 20% of th e public funds devoted to health care in its locality, and has a broad er agenda. It sets out to end any two-tier system discriminating betwe en the patients of fundholding and other practitioners within a locali ty by making it possible for all GPs to become fundholders within an o pen, democratic doctors' co-operative. Its declared aims are to mainta in equity and clinical integrity, to plan health care and to undertake scientific evaluation. Its overall goal is to preserve and improve up on the economic and ethical success of the British NHS. A brief evalua tion is included which suggests that Multifund members believe their o rganization is currently meeting most of these aims. The essay argues for GP-led Multifund systems centred on outcome evidence. A new genera lized global tool for measuring outcome, is being developed to assist in this process and it is briefly described here and is designed to fa cilitate: (1) the selection of cost-effective interventions, (2) the n egotiation of appropriate funding from government and (3) the demonstr ation of ethical behaviour in rationing health provision within a limi ted budget. It is envisaged that the Multifund's scope will be extende d, to administer the majority of the funds available for health care, by involving all local primary health providers and becoming a 'careho lding' consortium. This would mean obtaining local accountability thro ugh new community health forums and improving mutual trust through pub lic professional affirmations. If all this is successful multifunding could become a community-centred model for the management of health se rvice money which may in turn have international application.