THE REGULATION OF GENERAL-PRACTICE IN THE UK

When health professionals offer primary health services on a private m arket a number of problems can arise to do with choice, quality and su pplier-induced demand. Professional self-regulation through qualificat ion requirements and licensing procedures may offset some of the worst problems. However, in the UK, the primary health care sector is also subject to additional regulatory controls set within the context of th e NHS. Private practitioners within the NHS function in a quasi-market setting, in which they are funded by public health authorities to pro vide services free at the point of delivery to their patients. Within this context there is regulation of quality, entry, prices and profits . This system can be contrasted with the much less extensive set of re gulations applied to more market-based systems operating in countries such as the USA. Recent reforms in the UK have, however, initiated a m ovement towards a market-led system, extended the autonomy of health c are practitioners, and increased the scope of financial incentives as a mechanism to promote professional quality and innovation. This artic le draws on the insights developed in Propper (1993) in her study of r egulation and quasi-markets in secondary health care, education and co mmunity care. Its focus is on the extent of regulation in primary heal th care services; the effects of increased financial incentives on pro fessional performance brought about by the NHS reforms; and, the scope for further deregulation of professional services in primary care.