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The cornerstone of Labour's 'New NHS': reforming primary care


Author Info

  • Karen Bloor

    (Centre for Health Economics, The University of York)

  • Alan Maynard

    (Centre for Health Economics, The University of York)

  • Andrew Street

    (Centre for Health Economics, The University of York)


Two remarkable aspects of the Thatcher ‘internal market’ reforms of the NHS were the focus on creating a market for hospital services and the way in which primary care was treated almost peripherally in the 1989 White Paper (Department of Health 1989a). The 1991 NHS reforms introduced general practitioner (GP) fundholding almost as an afterthought, and the revision of the GP contract in 1990 Paper (Department of Health 1989b) was conducted separately from the implementation of other health care reforms. In contrast the principal focus of Labour’s ‘new NHS’ reform is primary care (Department of Health 1997). The intention of the government is both to improve the efficiency and equity of primary care provision and to develop Primary Care Groups and Primary Care Trusts which both provide care efficiently and act as agents who purchase secondary and tertiary care on behalf of patients. This is an ambitious agenda. This paper explores the policy context of Primary Care Groups in sections 1 and 2, describes and appraises the government proposals in section 3, and identifies major issues involved in the implementation of change in section 4.

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Bibliographic Info

Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 168chedp.

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Length: 27 pages
Date of creation: Apr 1999
Date of revision:
Handle: RePEc:chy:respap:168chedp

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Keywords: fundholding; rationing;


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  1. Given, Ruth S., 1996. "Economies of scale and scope as an explanation of merger and output diversification activities in the health maintenance organization industry," Journal of Health Economics, Elsevier, vol. 15(6), pages 685-713, December.
  2. Karen Bloor & Alan Maynard, 1993. "Expenditure on the NHS during and after the Thatcher years: its growth and utilisation," Working Papers 113chedp, Centre for Health Economics, University of York.
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Cited by:
  1. Adam Oliver, 2005. "The English National Health Service: 1979-2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S75-S99.
  2. Giuliano Masiero, 2001. "Patient movements and practice attractiveness," Departmental Working Papers 2001-05, Department of Economics, Management and Quantitative Methods at Università degli Studi di Milano.


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