ABSTRACT
This chapter looks at management initiatives to hold doctors to account. Governments past and present are convinced that primary care holds the key to better, more efficient services: good general practice is cost effective and keeps people out of hospital. A 1987 White Paper, Promoting Better Health, sought to apply lessons learned in the hospital sector from the Roy Griffiths reforms to the primary care arena; making bonus payments for reaching targets in certain specified areas and payments for general practitioners (GPs) in deprived areas. The impact of wider GP commissioning on accountability, both of the GP to the patient and of the hospital doctor to the GP, is unclear. The 1997 White Paper makes clear that health authorities will have a monitoring role which will hold both primary care groups and National Health Service (NHS) trusts to account over their health improvement programmes.
