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.
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To evaluate different methods for community based screening for sight threatening diabetic eye disease. ⋯ Since high sensitivity is essential for an effective screening programme, a photographic method should be considered as preferred option in national, community based screening programmes. Even in the hands of an experienced ophthalmologist, direct ophthalmoscopy is limited by weaknesses inherent to the instrument.