We measure the burden of fundholding in a year as the proportion of practices
which were fundholders in the following year to allow for the fact that fundholder
budgets were negotiated in the previous year.
The quality of the primary health care provided in the FHSAs is proxied by the
success of cervical cytology screening. Before the 1st April 1990 GPs were
rewarded for the number of tests given, while for subsequent years they received
target payments if they screened at least a specified proportion of women aged
25–64 on their list. Since information on cytology screening is generated only in
connection with payments to GPs we ensure longitudinal comparability by measur-
Ž . 14 ing the quality of screening by the FHSA’s z-score Armi