Incentives and health policy: primary and secondary care in the British National Health Service

This paper argues that issues concerning incentives and motivation are cruc ial to recent reforms to the British National Health Service, It examines h ow the incentive structure of General Practitioners with respect to the int erface between primary and secondary care changed with the introduction of GP fundholding, and how it might change further with the new Primary Care G roups. It concludes that the effectiveness of the internal incentive struct ure of the new groups will depend on the location of power within the PCGs, and that the external incentives involving the possibility of heavy centra l monitoring may affect the behaviour and motivation of GPs in potentially harmful ways. (C) 1999 Elsevier Science Ltd, All rights reserved.