ABSTRACT
The primary care-led policy appears firstly to be the culmination of increasing interest in community and primary care as a key means of achieving the government's laudable public health objectives such as Health of the Nation. Secondly it is the inevitable consequence of a politically dominated system in which management was viewed as slow to deliver and the medical profession as slow to change its practice. Partnerships could form between academic departments, consultancies and trusts to form development agencies, which could be given the bulk of the health agency primary care development budget, together with the staff whose expertise is in provider development. No doubt too the politicians were attracted by the philosophical justification of increasing the role of the private sector in the health care system. Although much beneficial change has been claimed, the National Health Service Executive-commissioned Scottish evaluation of fundholding shadow project has shown a major difference from non-fundholders in reduction of use of hospital consultant services.
