Competition or collaboration--the tensions within the purchaser provider relationship in nurse education

To explore the nature of the relationship between purchasers and providers from the perspectives of the key individuals involved in healthcare education in the late 1990s. To discuss the lessons that can be learned for nursing from their experiences.

Although the findings illustrate experiences of individuals at a specific time, the issues that arise have implications for contemporary health care, as contract use is increasing and, with the introduction of foundation trusts, contracts may replace Service Level Agreements.

The design was qualitative and the methods used were policy analysis and interviews. Interviews were conducted with a national, purposive sample of 70 participants.

The key finding was the amount of variation in effectiveness of relationships. Many purchasers and providers formed strong partnerships but a number had fraught relationships--a situation perceived as detrimental to productive working. A significant issue for current healthcare was the reasons why relationships worked well in some institutions and were ineffective in others.

There are a number of key lessons that can be learned about the nature of the relationship between purchasers and providers and applied to contemporary health care. Notably: .the value of clear policy aims; .the importance of context and history in shaping the relationship; .the necessity of ensuring that individuals involved have the ability and commitment to make the relationship work; .the need to view the contracting relationship as a dynamic 'project' that must be worked on; .the value of sharing good practice.