The impact of total purchasing and extended fundholding on mental health services: Baseline aims and objectives of sites

Abstract

Introduction : In the 'Total Purchasing' (TP) scheme, a general practice, or group of practices, had a delegated budget from the local health authority to purchase a range of services which were outside the standard GP fundholding scheme. 'Extended fundholding sites' (EFH) were given the freedom to develop purchasing in selected specialities. This paper reports on the initial findings from an evaluation of the impact of TP and EFH in relation to mental health services. Method: We carried out qualitative, semi-structured telephone interviews with representatives from 27 TP and 13 EFH sites. These were either the lead GP or the project manager at each of the sites. A total of 57 interviews were carried out between September 1996 and August 1997. Findings: Although the aims of the pilots were extremely diverse, a consistent objective has been to improve the communication and information flows between primary and secondary care. A popular means of trying to achieve this was to increase the number of specialist mental health staff working with or in primary care. Systematic needs assessment and the involvement of mental health services users have been low priorities for most of the sites. The aim of many sites to increase the number of mental health specialists working with or in primary care has been treated with caution by some Trusts. They are concerned that it may divert resources and staff away from people with severe and enduring mental health problems who have been identified by government as the priority for those in secondary care. Such issues will need to be considered by the new Primary Care Groups (PCGs) which will have the ability to commission mental health services from April 1999.