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Catching waves: the historical geography of the general practitioner fundholding initiative in England and Wales

Catching waves: the historical geography of the general practitioner fundholding initiative in England and Wales
Catching waves: the historical geography of the general practitioner fundholding initiative in England and Wales
General practitioner fundholding is often represented as one of the more successful elements of the 1989/90 Conservative reforms of the UK National Health Service (NHS). Successive annual ‘waves’ of fundholding practices were approved from 1990 through to 1997 and, over time, the initiative came to involve some 50% of UK general practitioners. Fundholding is known to have had a strong regional geography that changed with evolving fundholding eligibility criteria. Further, there have been persistent allegations that fundholding tended to occur disproportionately in areas of higher social status. Past studies of fundholding have tended to consider single waves or the overall impact of the initiative rather than its development over time. They have also tended to work at a single geographic scale or through single-region case studies when exploring the statistical regularities underlying the uptake of fundholding. Using multilevel analysis, this paper seeks to enhance understanding of fundholding through an examination of the interaction of district health authority and practice characteristics across all implemented waves for all general medical practices in England and Wales. We conclude that wave mattered on a national scale, that deprivation was relatively unimportant and that there were certain types of area that exhibited persistent but unexpected high uptake.
primary care, geography of health care, general practice fundholding, multilevel models, general practice, UK
0277-9536
2201-2213
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Mohan, John
30a03189-46ba-4ebf-895d-00fd1138325a
Twigg, Liz
41a8c6df-488f-4c0f-b38d-e83b8b41728c
McGrath, Kevin
1d1ac72f-48d1-4047-84b4-6da02d8bbc9d
Pollock, Allyson
394161b1-cd51-4e7e-9817-e730a066693b
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Mohan, John
30a03189-46ba-4ebf-895d-00fd1138325a
Twigg, Liz
41a8c6df-488f-4c0f-b38d-e83b8b41728c
McGrath, Kevin
1d1ac72f-48d1-4047-84b4-6da02d8bbc9d
Pollock, Allyson
394161b1-cd51-4e7e-9817-e730a066693b

Moon, Graham, Mohan, John, Twigg, Liz, McGrath, Kevin and Pollock, Allyson (2002) Catching waves: the historical geography of the general practitioner fundholding initiative in England and Wales. Social Science & Medicine, 55 (12), 2201-2213. (doi:10.1016/S0277-9536(01)00365-3).

Record type: Article

Abstract

General practitioner fundholding is often represented as one of the more successful elements of the 1989/90 Conservative reforms of the UK National Health Service (NHS). Successive annual ‘waves’ of fundholding practices were approved from 1990 through to 1997 and, over time, the initiative came to involve some 50% of UK general practitioners. Fundholding is known to have had a strong regional geography that changed with evolving fundholding eligibility criteria. Further, there have been persistent allegations that fundholding tended to occur disproportionately in areas of higher social status. Past studies of fundholding have tended to consider single waves or the overall impact of the initiative rather than its development over time. They have also tended to work at a single geographic scale or through single-region case studies when exploring the statistical regularities underlying the uptake of fundholding. Using multilevel analysis, this paper seeks to enhance understanding of fundholding through an examination of the interaction of district health authority and practice characteristics across all implemented waves for all general medical practices in England and Wales. We conclude that wave mattered on a national scale, that deprivation was relatively unimportant and that there were certain types of area that exhibited persistent but unexpected high uptake.

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More information

Published date: 2002
Keywords: primary care, geography of health care, general practice fundholding, multilevel models, general practice, UK
Organisations: PHEW – C (Care), Sociology & Social Policy

Identifiers

Local EPrints ID: 34890
URI: https://eprints.soton.ac.uk/id/eprint/34890
ISSN: 0277-9536
PURE UUID: 5953fd9d-a2da-46b0-8563-740ee7f40210
ORCID for Graham Moon: ORCID iD orcid.org/0000-0002-7256-8397

Catalogue record

Date deposited: 17 May 2006
Last modified: 17 Sep 2019 00:49

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Contributors

Author: Graham Moon ORCID iD
Author: John Mohan
Author: Liz Twigg
Author: Kevin McGrath
Author: Allyson Pollock

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