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A Tangled Web? Accountability and the Commissioning Role in the ‘New’ NHS

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This article analyses recent reforms to Primary Care Trusts in the NHS from a public law perspective. It critiques the complex web of accountability mechanisms to which the reforms give rise. Firstly, the reforms reduce PCTs' involvement in the provision of primary care services and give them a new role in purchasing or 'commissioning' these services. The concern here is that PCTs may find it difficult to call providers to account in the absence of a competitive market for primary care services. Secondly, the reforms involve making use of private contractors to assist PCTs in performing their commissioning role. This may lead to unnecessary complexity in the relationship between PCTs and providers, and may even result in conflicts of interest where the same firms are involved in both purchasing and provision. Thirdly, under a scheme called 'practice-based commissioning', GPs will have responsibility for managing budgets and redesigning services. They will be accountable to PCTs for their activities under this scheme. Although this accountability is important, it may stifle GPs' autonomy and thus their ability to innovate. The article calls for greater use of pilot-testing and empirical study in NHS policy-making.

Keywords: Accountability; National Health Service; practice-based commissioning; primary care trusts

Document Type: Research Article

Publication date: January 1, 2007

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  • Until 2007 the King's Law Journal was known as the King's College Law Journal. It was established in 1990 as a legal periodical publishing scholarly and authoritative Articles, Notes and Reports on legal issues of current importance to both academic research and legal practice. It has a national and international readership, and publishes refereed contributions from authors across the United Kingdom, from continental Europe and further afield (particularly Commonwealth countries and USA). The journal includes a Reviews section containing critical notices of recently published books.
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