ABSTRACT
For more than two decades numerous studies have documented variations in health care service delivery across small areas. The US and the UK have chosen somewhat different strategies for addressing physician behaviour and practice variation. Managed care plans have also used financial incentives as a means to increase physicians’ awareness of their practice patterns and performance. In the UK, the National Health Service (NHS) has long been regarded as a highly centralised top down health care delivery system. It is striking that recent reforms in the NHS emphasise physician networking and increased professional accountability rather than top down strategies as a means to changing physicians’ behaviour. Clinical governance is just getting underway in most Primary Care Groups but some common strategies are emerging. Organisational changes in the NHS are occurring in the context of declining public confidence in the health system and, by extension, the government.
