Implementing strategy : the politics of healthcare commissioning
- UK : Policy Press, jan. 1998
The purchaser-provider division in the National Health Service was intended to enable informed purchasers - general practitioner (GP) fundholders and district health authorities (DHAs) - to improve the cost-efficiency and quality of healthcare provision. Competition, or the threat of it, would encourage compliance from hospital and community trusts which previously had been protected by routinely provided resources. Although much attention has been given to the performance of GP fund holders, rather less interest has been paid to the activities of DHAs, whose task is qualitatively and quantitatively different from that of our GP purchasers. Drawing on research undertaken over a 15-month period, this article analyses a DHA's attempts to implement a purchasing strategy. It uncovers several factors contributing to the strategy's slow progress and concludes that factors constrained the DHA's ability to achieve strategic changes in an important service area