The UK White Paper Working for Patients, published in January, sets out the policy which sees patients more as consumers and introduces an “internal market” with separate purchasers and providers of services.
New NHS Trusts have their own autonomy as providers and they can negotiate with health boards who commission services. GP fundholding is another feature of this system, whereby family doctors have budgets and can buy services from trusts.
Advocates of the internal market claim it would make the NHS more efficient and responsive to patients. Opponents say it simply adds another layer of bureaucracy and does not run with the Scottish tradition of an integrated NHS based on co-operation not competition.