What is to be done about fundholding?

Objective: To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme.Design: Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996.Setting: Northern Ireland.Subjects: 23 first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders.Main outcome measures: Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing.Results: Prescribing costs and frequency increased in all groups throughout the study.Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders.The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing.However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders.The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later.Conclusions: After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing.