The market environment now means that GPs are no longer contracted directly to the NHS and corporate contractors can provide services using commercial contracts.
Professor Allyson Pollock and colleagues at the Centre for International Public Health Policy, University of Edinburgh, said that in March this year about 30 companies held commercial contracts to provide primary care services in England.
The authors warned in the BMJ this week that decisions about services had shifted from GPs to contractors, while commercial contracts had implications for service planning, public accountability, access to healthcare, and government control.
Market forces have also changed the legal basis of service provision, they said, replacing government regulation as the principal control.
BMJ 2007; 335: 475-7
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