BMJ : British medical journal
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To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the NHS reforms in April 1991. ⋯ No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates, although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year. Despite investment in new practice based facilities, no evidence yet exists that fundholding encourages a shift away from specialist care.