GPs and contracts: Bringing general practice into primary care

This paper argues that the terms on which GPs entered the NHS, as self-empl oyed contractors, have proved remarkably resistant to the managerial pressu res which have come to dominate other sections of the National Health Servi ce. However, this traditional made of financing and organizing the delivery of a key element of the National Health Service has become increasingly in compatible with wider health policy objectives-the development of an integr ated network of good-quality, equitable and well-coordinated Primary and co mmunity health services which are responsive to local needs. Furthermore, p rimary health services have themselves come to play a crucially important r ole in securing other strategic changes in the wider health policy arena, s uch as securing and sustaining a shift in the traditional balance between h ospital and community-based health services and controlling expenditure in a needs-led service. The paper argues that, notwithstanding the change of g overnment, the 1997 NHS (Primary Care) Act and the White Paper "The New NHS " are both integral to the achievement of wider strategic health policy obj ectives, such as improving the quality and coherence of services, and incre asing Professional accountability for the financial consequences of clinica l decisions. However, the greatest significance of these and other related measures is that they shift the emphasis of health policy from commissionin g and purchasing by primary can to commissioning and contracting for primar y case. They there by extend the exposure of GP-based services to manageria list scrutiny and control.