The politics of purchasing in the national-health-service

With the 1992 NHS reforms and the introduction of the internal market a new political game has begun where, for the first time, the rationing of the supply of health care to make it fit unlimited demand is the explicit responsibility of purchasing agents (DHAs, FHSAs and GP Fundholders). This paper analyses the inherent clash between purchaser rationing and traditional NHS values, the unbridled pluralism of the gameplay surrounding the purchaser function, and the absence of accepted rules and procedures. It concludes by reviewing the implication of the reforms for the distribution of power in the NHS.