Elements of decentralisation in plans to reform NHS may prevail

BMJ 1998;317:753 ( 12 September )

Letters

Elements of decentralisation in plans to reform NHS may prevail

The first 150 words of the full text of this article appear below.

EDITOR $---$ Klein and Maynard correctly diagnose centralising tendencies in the government's approach to the management of theNHS.¹ What they fail to acknowledge is that there are alsodecentralising tendencies, and it is unclear which of the twoapproaches will prevail.

Decentralisation is most evident in the establishment of primary care groups. These groups will play a major part in the commissioningand provision of services in the future. The reluctance of somedoctors to participate in primary care groups, for fear that theywill be made responsible for rationing and have to accept responsibilityfor unpopular decisions, indicates that the phenomenon of "blamediffusion" in the NHS (which Klein has analysed over many years)is alive and well. Whether the emphasis on setting national standardsfor the NHS and intervening to ensure that these standards areachieved will prevail over the attempt to empower doctors andnurses locally . . . [Full text of this article]

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