Private provision of 'outreach' clinics to fundholding general practices in England.

Objectives: To establish the contribution of the private sector in providing outpatient 'outreach' clinics in general practitioner fundholding practices.

Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995.

Results: Fourteen practices responded. Ten practices had set up at least one medical specialist 'outreach' clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant 'outreach' clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology.

Conclusion: This small study identified considerable private provision of fundholders' 'outreach' clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.