Education And Debate The NHS revolution: health care in the market place

Competition in general practice

BMJ 2005; 331 doi: (Published 17 November 2005) Cite this as: BMJ 2005;331:1196
  1. Martin Marshall (, professor of general practice1,
  2. Tim Wilson, general practitioner2
  1. 1National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
  2. 2Mill Stream Surgery, Benson, Oxfordshire OX10 6RL
  1. Correspondence to: M Marshall

    UK general practitioners seem likely to face competition for their services. Can the market place improve on the weaknesses of primary care without affecting its strengths?


    General practice is bracing itself. After more than seven years of reform in the United Kingdom's acute sector, the political spotlight is now falling on primary care. A new contract was introduced in 2004 linking up to 20% of a practice's income to specified activities,1 and further reform is on its way. General practice might be regarded by international observers as the jewel in the crown of the British health system,2 but some policy makers are suggesting that it needs to be shaken up if it is to play its part in delivering a high quality, patient centred NHS. The government looks set to introduce some sort of competition into the primary care market. We explore the purpose of such a policy and its implications for patient care.

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    Walk-in centres suit patients who value accessibility over continuity of care


    General practice reforms

    Much of the discussion about the future of general practice focuses on the nature of reform, rather than on its purpose. What options are people advocating? Some think it best to leave quality improvement in the hands of the medical profession, with the emphasis on formative educational approaches. Others think that the answer lies in actively managing performance, using targets and incentives to deliver measurable improvement. But there are policy makers who believe that these approaches have failed to deliver the required nature and pace of change. The future, they suggest, lies in market based solutions, exposing NHS providers to greater competition. The government seems to agree. Alternative models of primary care provision are currently being introduced into communities that have failed to replace retiring general practitioners.3 In addition, …

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