BMJ  2007;335:475-477 (8 September), doi:10.1136/bmj.39303.425359.AD

Feature

Health policy

The market in primary care

¹ Centre for International Public Health Policy, University of Edinburgh, Edinburgh EH8 9AG, ² Department of General Practice, University of Glasgow, Glasgow

Changes to primary care have shifted clinical control away from general practitioners and financial control away from government, argue Allyson Pollock and colleagues

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

Since 2003 the government has created a market in primary care and replaced the old general medical services contract governing general practitioners with a range of alternatives. The changes gave primary care trusts in England, health boards in Scotland, and local health boards in Wales new powers to negotiate contracts with commercial companies.^{1 2} Many of the changes to regulation were intended to facilitate the entrance of new providers to the healthcare market.³ General practitioners are no longer contracted directly to the NHS but to the firms or practices that contract with primary care trusts in the market. These bodies are in turn regulated largely through the market mechanism of commercial contracting. We explain how the reforms change the basis of government control and mechanisms for public accountability in primary care and the possible effects on staff and patients.

Breaking the monopoly

The primary care market is premised on the break-up of the general . . . [Full text of this article]

Change in legal basis for service provision

Unbundling primary care services

Regulatory framework and professional control

Implications of the reforms

Summary points

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This article has been cited by other articles:

• Rosenthal, T. C. (2008). The Medical Home: Growing Evidence to Support a New Approach to Primary Care. J Am Board Fam Med 21: 427-440 [Abstract] [Full text]  
• Gillam, S. (2008). Is the declaration of Alma Ata still relevant to primary health care?. BMJ 336: 536-538 [Full text]  
• Beerstecher, H. J (2007). More questions than answers. BMJ 335: 735-735 [Full text]  

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