All change in the NHS - Implications of the NHS reforms for primary care prevention

The paper provides a review of the implications of the recent NHS reforms - i.e. the Griffiths Report (1983), Promoting Better Health (1987), Working for Patients (1989) and the new GP contract (1990) - for primary care prevention. Three major themes are identified as the leitmotivs running through these reforms: first, the introduction of general management into the NHS; secondly, the introduction of market principles into the NHS, and; thirdly, the increasing emphasis upon health promotion and disease prevention. The first section of the paper offers a critical review of the Government's health promotion strategy, one in which, it is argued, the primary care sector will play a central role. Hence, taking the issue of primary care prevention as a case-study, the paper then proceeds to discuss the implications of these recent reforms (i.e. managerialism and market principles) for primary care prevention at a number of different levels: namely, for FHSAs, DHAs, GPs, nurses, and consumers. The final section of the paper considers the potential impact of these reforms for the professional autonomy of GPs and nurses, particularly in relation to the proletarianisation and deprofessionalisation theses. The paper concludes with a theoretical discussion and interpretation of the themes and issues raised within the course of the paper.