The patient's view of general practice fundholding: Results of a cross-sectional survey

We report the results of a survey of patients' awareness, attitudes and satisfaction regarding fundholding and related developments in primary care, and compare the responses of patients in fundholding and non-fundholding practices. (Six total fundholding general practices and two non-fundholding general practices in West Berkshire were included.) An anonymous postal questionnaire was sent to 1150 patients with joint pain aged 17-80, of whom 715 (63%) returned completed questionnaires. Few (17%) fundholding respondents had received information from their practice about fundholding or (36%) were aware of new or different services being offered but the majority had heard of fundholding and were able to describe it accurately. Satisfaction with GP services was high in both types of practice, but fundholding patients reported higher levels of satisfaction with getting a referral to a hospital specialist (FH: 81% vs. NFH: 63%), and with the length of time between referral and treatment (FH: 81% vs. NFH: 59%). A majority of patients in both types of practice wanted to be involved in decisions about the services available to them but only a third of patients thought that fundholding would make this easier. Fundholding patients were more likely to report being given enough choice about treatments available to them (51%) than their non-fundholding counterparts (35%). Fundholding patients had not perceived a reduction in quality of care as a result of budgetary pressures and were more satisfied with the process of referral to secondary care than their counterparts in non-fundholding practices. Patients in both types of practice felt that it was important to be involved in decisions about the services available to them, but few thought that this would be more likely as a result of fundholding. Provision of information to patients is a prerequisite for their involvement, but judging by the number of patients receiving any information about fundholding from their practices this aspect of the reforms does not seem to have been implemented.