There are many similarities and convergences, but also contrasts, between budget holding in New Zealand and UK fundholding. Independent practice associations range in size from large group practices to the Auckland-based ProCare Health which has a membership of 340. Larger groupings are able to take on much wider range of services including all secondary care services with minimal risk for member practices. They are thus able to gradually build up experience and competence in budgetary management and administrative and information systems. Extension to secondary care involvement is based upon this graduated experience.
Budget holding savings are real and are held by the association.
Savings are used to provide new services as determined by the association in conjunction with purchasing health authorities. These include free or reduced cost of access to the only partially subsidised general practice services, free mammography, improved immunisation programmes, terminal care, etc. Practices contract with their association which in turn negotiates contracts with purchasing authorities. But this raises questions about the commitment of individual general practitioners to the goals of their associations and how they can be more involved especially in large groups. However, as is the trend in the UK, larger groups offer a more powerful peer review process for improving both quality of care as well as accountability for costs.