Suchergebnisse

Cover -- Half Title -- Series Page -- Title -- Copyright -- Dedication -- Contents -- List of illustrations -- Part I: Background -- 1 Preparing the ground -- Outline -- The importance of the Second World War -- The origins of change -- The Beveridge Report -- Post-war negotiations with the doctors -- The NHS -- The importance of taxation -- Key points -- Guide to further reading -- 2 Change and development -- Outline -- Introduction -- Changing the structure 1948-74 -- Public health care 1974-82 -- Changing the structure again - 1982 -- Changing the processes - Griffiths and after -- The NHS and the internal market -- Key points -- Guide to further reading -- 3 The health care arena -- Outline -- Introduction -- The informal sector -- The voluntary sector -- The commercial sector -- The moving picture -- Key points -- Guide to further reading -- Part II: The issues -- 4 Resources, rationing and morality -- Outline -- Introduction -- Resourcing health care -- Allocating health care -- Rationing health care -- Key points -- Guide to further reading -- 5 Interest groups in health care -- Outline -- Introduction -- Pressure groups and the NHS -- Doctors -- Nurses -- Managers -- Citizens and patients -- Changing relationships within the NHS -- Key points -- Guide to further reading -- 6 Managerialism, cultures and control -- Outline -- Introduction -- Public and private -- The cultural impact -- Ownership, control and access -- Measurement: aiming at the wrong target? -- Key points -- Guide to further reading -- 7 Inequality in health and health care -- Outline -- Introduction -- Minority groups and discrimination -- The case for equalizing opportunities -- Class -- Gender -- Race -- Equal opportunities in the NHS -- Looking to the future -- Key points -- Guide to further reading -- Part III: The future - new possibilities.

The changes currently being introduced to the ways in which health care is delivered in England, under the general heading of the new NHS, have the potential to be more than just evolutionary and to transform the NHS from one which has been dominated by the secondary sector into one driven by the primary sector. But they do not start from a tabula rasa, retaining the commissioning-providing split which was a feature of the internal market, but giving the commissioning responsibility to newly-constituted Primary Care Groups to which all general practices now belong. There had already been some experimentation along these lines before the Labour Government took office, with a number of Total Purchasing Pilots in different parts of the country, one of which was Wakefield Health Authority. This paper examines what is happening in Wakefield, and begins to assess developments there against a template, proposed by the authors, suggesting the essential features of a primary care led NHS.