ABSTRACT
The main purposes of this chapter are to provide some conceptual clarity about notions of 'equity' in the context of healthcare, and to examine the concept of policy 'implementation' with special reference to new forms of primary medical care organisations in the English National Health Service. It gives specific expression to the broader issues raised in the previous chapter and will serve as background for subsequent chapters: both the substantive accounts of specific health problems and the discussions of how the NHS might contribute to greater equity for South Asian ethnic minorities. This conceptual background should make it clear that pursuit of such equity is far from unproblematic, for this is a subject matter where real discrimi nation and disadvantage meet genuine conceptual and organisational complexity and puzzlement. The following is divided into five sections. The first elucidates concepts of equity, highlighting those upon which NHS policies have tended to concentrate, showing that little systematic attempt has been made to address inequity for ethnic minorities. The second section examines the concept of imple mentation, whilst the third and fourth relate it to new organisational forms (primary care trusts) and processes (clinical governance) in NHS primary care. The final section concludes that, although the new National Service Frameworks may bring particular benefits to members of South Asian minorities, the requirements of clinical governance will in many cases inhibit any wider project of equity for them. Of course it does not follow from this that the project should be abandoned or attenuated and it seems possible that individual general practices, rather than the new larger primary care organisations, will be best placed to pursue it.
