ABSTRACT
The pace and scale of change was revolutionary, but so too more significantly was the effect on ‘development’ itself. The contemporary National Health Service (NHS) has felt from the inside as if it is undergoing just such a revolutionary period. In structural terms the management basis for devolution in the NHS has been the adoption of a standard population based funding formula for nationwide application. The identification of the NHS with secondary care institutions, however, conditions people all. The new theology of the separation of purchasing and providing functions is blasphemed against by the expanding range of primary managed care organizations that decline to differentiate between the two as they apply the holistic ethos of general practice to commissioning. These organizations themselves are assuming a range of organizational status that makes the 1990 GMS contract’s attempts to confirm the monopoly of the legal partnership in general practice seem a Canute-like anachronism.
