The concept of fundholding is the latest, and perhaps the most far reaching, change in the delivery of patient care since the NHS was conceived. It was outlined in a White Paper Working for Patients published in 1989. This document gave the plans for the future of the NHS and the main initiative was the introduction of general practice fundholding. In 1990 the GP Contract was introduced, which shifted the emphasis away from basic allowances to a greater number of item of service payments and increased capitation fees. In other words, to maintain a level of income each GP needed to provide a full range of patient services. Almost by default, each practice had to become more businesslike in its approach to utilizing resources, or suffer the consequence of a drop in income. General practitioners were ideally placed to spearhead a major initiative to identify and improve the services needed by their patients. They were also the best equipped in terms of business experience, most practices having a defined management structure, decision-making forum and an in-built accountability to colleagues and patients.