ABSTRACT
In this chapter, the author's colleagues at the London think-tank Reform said in their report on National Health Service (NHS) Reform that the present changes in the NHS introduced by the government are ‘coherent and right’. And so instead of taking the lead in the flagship NHS policy of ‘practice-based commissioning’ the primary care trusts (PCTs) in charge are often obstructing the policy. Practice-based commissioning is intended to devolve some of the purchasing work to general practitioners (GPs) from PCTs. However, many GP practices have used new budgets to pay for the direct provision of their own services, and have further limited potential competition. Some have bought services from outside firms which some partners of the same GPs also own. There is opposition to change from GPs, consultants, national professional bodies, and from many PCTs.
