Education And Debate

Primary care: opportunities and threats Deregulating primary care

BMJ 1997; 314 doi: (Published 15 February 1997) Cite this as: BMJ 1997;314:506
  1. Angela Coulter, directora,
  2. Nicholas Mays, director of health services researchb
  1. a King's Fund London W1M 0AN
  2. b King's Fund Development Centre, King's Fund Policy Institute
  1. Correspondence to: Dr Coulter


    The 1996 primary care white paper, Choice and Opportunity, offers scope for a wide range of new organisations to enter the market for NHS primary care. If the new law is implemented it will sweep away many of the existing legislative, budgetary, and procedural barriers to innovation, initially through a range of pilot schemes. Full implementation could end general practitioners' monopoly of general medical services and permit experimental alternatives to the single national contract for general practitioners. Such pilots have the potential for creating better primary care, especially in inner cities, through new employment options, such as salaried posts. There are, however, considerable risks. For example, the legislation will allow piloting of new forms of vertically integrated provider organisations, thereby eroding the purchaser-provider separation established by the NHS changes of 1991. The proposals in the white paper also require local health authorities to develop primary care and regulate the pilot schemes at a time when they have lost many staff. To ensure equity of innovation pilots must emerge where primary care most needs improving and pilots must be evaluated thoroughly before they are applied widely.


    Big bang or damp squib?

    The launch of the primary care white paper, Choice and Opportunity,1 last October was accompanied by a rash of newspaper headlines heralding a revolution in primary care provision. Reports said that pharmacy chains such as Boots and UniChem, American managed care organisations, and even the supermarket chains Tesco, Asda, and Safeway were considering offering primary care services.2 3 4 5 Since October, concern has been growing about the consequences of the imminent break up of the general practitioners' professional monopoly and about the risks of allowing hospitals or commercial organisations to provide primary care.6 7 8 Despite this, ministers have attempted to downplay the headlines and have …

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