ABSTRACT
The power afforded general practitioner fundholding, with its emphasis on local diversity and the pre-eminence of the sovereign general medical practice in the primary care-led National Health Service (NHS), helped create further space for the entrepreneurs in general practice to develop organisations and services designed to deliver optimum care for their patients. The franchise system is a modern organisational structure made for primary care trusts (PCT). In the commercial sector, the likes of Virgin have helped ensure that it has gained the public’s confidence. To approach the options and to make sense of them it is important for PCTs to apply scenario planning with the same rigour as the strategic approach adopted for the NHS plan. Restoring an ethical basis to healthcare is probably just about the biggest contribution that PCTs can make to the NHS, its patients, its professionals, and, in particular, its politicians.
