An Application of Keaveney’s Model of Service Switching Behaviour to GP Fundholders

The introduction of competition within the National Health Service (NHS), with the purchasers having a degree of choice among providers, has raised a variety of issues for buyer-supplier relationships. Purchasers, especially GP fundholders, have power in relation to their provider in the sense that they may ultimately take their custom elsewhere and by transferring their business, or part of their business, from one trust provider to another. As GP fundholders increase in number, and in confidence, this practice seems likely to grow. Using evidence from commercial markets, this article explains why fundholders might switch provider and the implications this has for hospital trusts.