GP Fundholding (Hansard, 30 June 1997)

§ Mr. Willis
To ask the Secretary of State for Health what plans he has to reform the GP fundholding arrangements. [4286]

§ Mr. Milburn
We mean to work with all in the National Health Service, including fundholders, to develop new arrangements for primary care led commissioning which best meet our objectives of providing equal access to high quality care to all, on the basis of need, cutting out inefficiency and bureaucracy.
To create time for this, entrance to fundholding has been made biennial, deferring entry to the 8th fundholding wave until July 1999. We have also taken steps to reduce bureaucracy and tackle the financial advantages of fundholders, ensuring that the patients of non-fundholders are no longer disadvantaged.
For the future, we shall wish to draw on good practice from the range of existing models of General Practitioner activity in this field. We are also mounting a programme of pilot projects for GP commissioning groups, to complement existing models and explore new approaches to meeting our objectives.

§ Mr. Truswell
To ask the Secretary of State for Health how he plans to ensure(a) that GP fundholding budgets are spent, (b) that such expenditure is clearly focused on patient care and (c) that underspends are either properly planned and sanctioned or recouped. [5283]

§ Mr. Milburn
We have made it clear, in EL(97)33, that savings which arise from one-off windfalls or from random dips in demand should be returned to the Health Authority or held against future budget pressures. It is for fundholders and Health Authorities to work together to determine the underspend value which falls into these categories.
The application of fundholders' budgets is governed by regulations. These provide that budgets may be used in year only for patient care and the management of the practice; and that audited savings may be used for the same purposes or for a range of additional specified purposes, namely improvements or extensions to premises; material or equipment for healthcare, management or health education; clinical audit; research and development; and training.
Fundholders' proposals to use savings are set out in their annual practice plans, and those for the additional purposes are dependent on Health Authority agreement that they represent value for money and will benefit patients. Savings must be applied within 4 years or they revert to the Health Authority.