Reforming British primary care (again)

It's hard to know what the changes will mean for patient care

Editorials p 748, General practice p 772, Education and debate p 797, Letters p 803

On 1 April all general practitioners in England and Wales will have to start working collaboratively in large local groups to commission and, in some cases, purchase secondary care for the populations they serve. 1 2 To general practitioners and many others in the NHS this is hardly hot news: they have been preparing for this shift since early last year. But, given that the NHS, and primary care in particular, has changed its structure so many times in the past decade, we thought that some BMJ readers could do with a little explanation.

In the early 1990s the Conservative government tried to contain increasing demand and rising costs in the NHS by splitting the service into provider trusts (hospitals and community and mental health services) and purchasers (health authorities and some general practitioners, called fundholders).3 Because general practitioner fundholding …