GP fundholding has arguably achieved more desirable changes in health provision than any other facet of the health service reforms, but as a policy it remains incomplete and deeply flawed. The challenge is to build on the policy without losing the considerable positive achievements of the scheme. Christopher Fewtrell describes how North Derbyshire Health Authority approached this complex policy dilemma.
The contraction of long stay psychiatric and mental handicap hospitals in Northern Ireland started later than in England and is proceeding more slowly. So far, the process appears to be a carefully planned one. Michael Donnelly and Nicholas Mays report.
Working for patients established a new system of contracts between providers and purchasers of healthcare, with prices based on full costs, avoiding cross-subsidization. The new regime necessitates greatly improved costing systems, to improve the efficiency of service provision by creating price competition between providers. Ken Bates and Stan Brignall argue that non-price competition also occurs, with providers 'differentiating' on quality of service/product, flexibility or innovation.
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