Academics' development of the idea of GP fundholding

A discussion meeting at Cumberland Lodge on 7 and 8 June 1984, attended by academics and a range of system leaders, considered a number of papers on how the NHS would need to change to be fit for the 1990s.

The group discussed the possibility of a primary health care unit being the budget holder for primary and secondary care, which would 'permit an entrepreneurial competitiveness'.

In a follow-up meeting on 30 October 1985, Alan Maynard's paper on performance incentives in general practice further developed the concept of GPs as budget holders. This was soon picked up within the Department of Health.

It was thought that GPs would be closer to their patients and would be in a better position to act as informed, expert purchasers, thereby providing incentives for the acute sector to make improvements.

Each patient would have a per capita value, which translated into the GP's income when the consumer selected and signed on with the GP. In this way, the GP generated income by competing for patients and would use that income to finance primary care, but also to buy in other services such as hospital care (private or public, whichever was cheapest).