Britain's Health Care Experiment

Prologue: Changing political and economic tides during the 1980s forced the British government to examine anew its National Health Service (NHS). Former Prime Minister Margaret Thatcher's Conservative government, pushed by the threefold forces of budgetary constraints, rising public expectations, and demands for increased productivity, undertook a revision of the service that enraged the medical profession. For the first time in forty years, British general practitioners (GPs) will cede some of their prized clinical autonomy to managers and purchasers. In this article, Patricia Day and Rudolf Klein examine the revisions to the NHS. They state, “In the context of the NHS culture, this move from … trust to contract is truly revolutionary and has perhaps the farthest-reaching long-term implications' of any reform to date. This, rather than competition, is going to “distinguish the new-style NHS,” the authors assert. Day, who received a sociology degree in London, has been a social policy research officer at the University of Bath since 1980. She has researched internal communications and organization of London hospitals, has studied the purchasing and supplies organization of the NHS, and also has studied public housing in the London borough of Camden. Klein, born in Czechoslovakia, received his master of arts degree in modern history from Merton College, Oxford, and spent several years working as a journalist with the London Evening Standard and Observer . Currently he is director of the Centre for the Analysis of Social Policy at Bath, which he founded, and is professor of social policy there. He has been a specialist adviser to the Social Services Committee of the House of Commons, joint editor of Political Quarterly , and consultant to the Organization for Economic Cooperation and Development. He published an article on the NHS in Health Affairs , Spring 1985, entitled “Why Britain's Conservatives Support a Socialist Health Care System.”