ABSTRACT
The National Health Service (NHS), being a public service, there is very little scope for earning significant amounts of money. There are three fundamental ways by which the NHS could get more for its money. These are: reduce costs - fixed and variable; increase productivity; and increase prices. The NHS has certain characteristics which make the afferent doctrine of management the most appropriate. Proponents of managed care and evidence-based medicine believe that they are best disseminated via guidelines or protocols and/or by continuing medical education. A significant amount of effort is required for continuing medical education which will take consultants away from the work for which they are paid by the public. The Working for Patients proposals for securing and providing services envisaged an 'internal market' in which the health authorities purchased services on behalf of their population from provider units such as Trusts.
