Change in the NHS

This paper tries to set the current changes in the British National Health Service in historical perspective. The NHS was born in 1948 amid controversy, both political and professional; but in the 50s and 60s a consensus was reached which won it the support of patients and doctors. But in the 70s and 80s it has undergone the stress of successive reorganizations, in the attempt to meet the economic strains imposed by an ageing population and expensive medical advances. The present changes aim to bring about an "internal market," regulated by contract between "purchases" and "providers." Reasons are given for the view that this artificial arrangement will impair the coherence of the NHS, will add administrative expense and complexity, and will impair the important role of general practitioners as "gate-keepers."