A primary care market?BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7050.127 (Published 20 July 1996) Cite this as: BMJ 1996;313:127
- Chris Ham
- Director Health Services Management Centre, University of Birmingham
May bring benefits but needs thorough evaluation
It is a fact universally acknowledged that primary care is one of the great strengths of the British health care system. The NHS reforms initiated by Margaret Thatcher in 1989 have shifted the balance of power towards primary care and resulted in more services being provided by general practitioners and colleagues in primary care. This in turn has led to the emergence of new kinds of primary care organisation. These include fundholding practices, multifunds, total purchasing projects, commissioning groups, and out of hours cooperatives. The formation of these organisations is beginning to break down professional isolation among general practitioners and is creating opportunities for greater collaboration. Paradoxically, it is also opening up the prospect of increased competition between primary care providers.
Of particular importance in this context is the establishment of unified health authorities in England and Wales in April 1996 and the responsibility given to these health authorities to promote the government's policy of a primary care led NHS. There is already evidence that those heading the new authorities are keen to move beyond the traditional model of general practitioners working through partnerships to deliver a standard …