Modelling the behaviour of general practitioners: a theoretical foundation for studies of fundholding

Despite its potentially profound repercussions, the general practitioner fundholding scheme has received relatively little attention from researchers. We provide here a theoretical foundation for empirical studies of fundholding. We begin by reviewing the incentives of the fundholding scheme. The responses of GPs to these incentives depend on the objectives of GPs, raising the questions: what are GPs trying to maximise? What GP objectives are useful in explaining their behaviour? After addressing these questions, we formulate several models of behaviour, focusing in turn on referrals, prescribing, workload and the agency relationship between the GP and the patient. These models illustrate how we can provide a conceptual basis for researching various aspects of fundholding. Modelling GP behaviour yields several benefits: it induces us to explicitly identify our assumptions; it illuminates the interactions between incentives and GP objectives; and it can suggest interesting empirical questions. Studies based on such explicit analytical frameworks can elucidate how GPs respond to the incentives of the fundholding scheme.