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Fund-holding and commissioning general practitioners

Recent government policy and legislation

Health Centre, Chertsey, Surrey KT16 8HZ and Department of General Practice, St George's Hospital Medical School, London SW17 0RE

General practice fund-holders purchase secondary care for their patients directly, encouraging competition between providers. The scheme now includes almost all community mental health services. Practice counsellors may now be funded from secondary care budgets. Fund-holders may use their purchasing power to influence out-patient policies, have consultant sessions in their surgeries, gain direct referral to community psychiatric nurses, resist sectorisation, or change to a different provider altogether. The implications for mental health teams and their patients are discussed. Mental health workers must define their roles very clearly, and get involved in negotiating contracts now, to influence future service provision.