Here we go again: Repeating implementation errors

Abstract

The NHS reforms are promising, but some mistakes of implementation by the last government are being repeated by this one. Primary care groups, like health authorities in the 1990s, lack the resources, latitude, and incentives to commission effectively. Primary care groups will be taking on greater proportions of healthcare services but are not in line for greater proportions of the budget. The reforms embody conflicting models of governance - hierarchical control versus devolved commissioning - with doctors and nurses caught in the crossfire. Integrating primary, community, and social services and commissioning them effectively is the first order of business. Health authorities have major new responsibilities on top of the old ones and need to be strengthened.