ABSTRACT
This chapter outlines the nature and scope of the changes occurring in the relationship between the medical profession and the direct and indirect users of the profession - namely, patients and government/providers, respectively. It documents the introduction of ideas of performance management and monitoring for doctors, and the tools that have been used to achieve this. Medical involvement with management, and responsibility for resource utilisation, began in earnest with general practitioner (GP) fundholding. The principle that doctors need to take an interest in resource allocation has outlived fundholding and, indeed has now become one of the tenets of the General Medical Council'sGood Medical Practice. A potential advantage of commissioning is that it can be used to ensure that services attain a predefined standard. The increasing need for clinicians to be engaged in and accountable for decisions about the use of resources in the healthcare system has been a driver for the advance of evidence-based medicine/practice (EBM) in the United Kingdom.
