Replacing the NHS marketBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7117.1175 (Published 08 November 1997) Cite this as: BMJ 1997;315:1175
The white paper should focus on incentives as well as directives
- Chris Ham, Directora
- a Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
The British government is working on a white paper to be published by the end of the year outlining its plans for replacing the NHS market. The likely flavour of the white paper has already been indicated in ministerial speeches that have emphasised the government's desire to avoid another reorganisation, to pilot its own policies before they are implemented across the NHS, and to encourage cooperation and team working. The test will be the ability of the white paper's authors to translate these aspirations into practical proposals. Three central questions have to be addressed: If competition is to be abolished, should the separation between purchasers and providers be maintained? What will happen to general practitioner fundholding? And, without competition, what incentives will there be to improve performance, especially when funding is tight?
The argument for ending the separation between purchasers and providers rests on the view that these responsibilities are intrinsic to the NHS market and that a commitment to replace the market should logically result in the integration of health authorities and NHS trusts. As experience has …