THE FUTURE OF FHSAS .1. FROM FPC TO FHSA TO ... HEALTH COMMISSION

The transformation from family practitioner committee to FHSA signalled a shift towards serving the public and servicing rather than serving independent contractors. FHSAs were charged with improving the range, quality, cost effectiveness, and consumer responsiveness of the family practitioner services component of primary care. FHSAs were given increased discretion over funding of premises and staff developments in the general medical services, but few sanctions. Impediments to their attempts to procure local improvements, such as the continued powers of the medical practices committee and their own lack of discretion over allocation of Jarman payments, remain. Nevertheless, most FHSAs have far deeper and more comprehensive knowledge about practice activity than previously, and are increasingly 'trading' allocation of resource and development to practices in return for greater practice accountability. Their closer relationships with GPs have illustrated the difficulties of achieving improved primary health care without greater integration of general medical services with community health services, leading some FHSAs to engage in joint commissioning of primary care with district health authorities. Fundholding has developed differentially across the country and in some places will soon cover the whole population. Because of the regional health authorities' lead role in establishing fundholding, some FHSAs have remained marginal to this development. The complexity of services fundholding practices will purchase by April 1993 makes it imperative that they be held accountable, as locally as possible, for their performance as both purchaser and provider. This task will require commissioning authorities that contain members and managers experienced and competent in commissioning both primary and secondary care.