2 Apr, 13 by BMJ Group
April 1 2013 saw the launch of a very different type of NHS in England. The current government has grappled with the same problems as all previous governments, but imposed radical surgery on an ageing patient.
The previous government struggled with the problem of getting improved productivity and common high standards out of a largely monopoly service. The NHS has always delivered its services through a mixture of employed staff and contracted private sector operators. GP practices have always been private sector businesses that are paid by the NHS for the services they deliver, but without GPs ever being NHS employees. How they swung the right to get NHS pensions is another story but just shows the negotiating brilliance of the BMA. But competition plays only a small part in GP services. There is no active recruitment by one practice of the patients signed up to the practice down the road (although maybe we will see this now).