ABSTRACT
The new NHS is still taking shape, with further changes to its structures and functions announced as this book was being fi nalised. Plans are well advanced for mergers and reconfi gurations of PCTs and SHAs. Crucially, the DH White Paper Our Health, Our Care, published in January 2006, made it clear that the government intends to contract out to the private sector the commissioning functions and budgets of PCTs through ‘practice-based’ commissioning.1 Under practice-based commissioning providers of GP services will hold the budgets and commission all medical services, including primary care, community health services and hospital care. The DH is working with a number of large corporations, and PCTs are contracting with US companies like UnitedHealth Europe and Kaiser Permanente to operate GP practices and provide community health services;2 through practicebased commissioning they will become the health care commissioners for the patients in their care.
