NON-FUNDHOLDING IN NOTTINGHAM - A VISION OF THE FUTURE

The 1991 health service reforms introduced the internal market and gav e individual fundholding practices budgets with which they could attem pt to secure preferential access to secondary health care for their pa tients. In the view of many doctors this undermined the principle of e quity on which the NHS was founded. In Nottingham 200 non-fundholding general practitioners have joined together to act in liaison with thei r purchasing health authority. A committed representative group of gen eral practitioners can collectively offer more time and knowledge to t he contracting process while minimising the impact on clinical workloa d. As a large purchaser with low management costs the group has secure d access to quality secondary care which is equitably available to all patients, preventing the development of a local two tier service. Not tingham's non-fundholding model of commissioning is equitable and effi cient.