ABSTRACT
This chapter focuses on published evidence from a range of academic disciplines and from a continuing research project involving fourteen general practitioners (GP) practices to analyse the impact of the changes. It argues that the government has created an ‘illusion of freedom’ for GP practices. Family practitioner service expenditure was viewed as a particular problem by the incoming conservative government in 1979 because spending by GP’s was ‘open-ended’ and ‘demand-led’. The government has approached accountability and market changes with a particular view of ‘professionalism’. The ‘micro’-rationing decision for referring individual patients now becomes one for the individual fundholding GP to take, with all the potential ‘blame’ if treatment is delayed or refused. GP’s are being forced to ration in their capacity as fundholders, and they can no longer ‘delegate’ micro-rationing decisions to their hospital colleagues. The government has imposed accountability and market changes on GP practices with three clear aims.
