THE PURCHASER-PROVIDER SPLIT IN THE NHS
In my previous article, commenting on the introduction of the management structure in the NHS proposed by Griffiths I quoted several commentators saying that the immediate impact was not great - that the clinicians often proceeded as before, regardless. But that would have come to an end with the introduction, in the early 1990s, under legislation prepared by Kenneth Clarke, of the 'internal market' or at least, since it was not a real market, of the purchaser-provider split. Very broadly speaking, the purchasers were the District Health Authorities, the providers were the hospitals, but the ambition of the Conservative government was that GPs would agree to be the purchasers. In other words that they, instead of the District Authorities, would receive money directly from government which they would then use to purchase equipment and hospital services on behalf of their patients.
Obviously the ideal for this line of thinking would be that the patients themselves would become the purchasers. The 1979 Conservative manifesto had floated the idea of turning patient into fundholders/consumers through the introduction of an insurance based scheme on the US (and European) model but this was, in the event, considered politically impossible. The purchaser/provider split was still a very radical rethinking of the British culture of public service management but thanks to Griffiths and, I am suggesting, the rapidly expanding culture of the Business Schools, there was in place the beginnings of a network of managers with some knowledge as to how such a system would operate. One can imagine them being a bit lost in the informal, non-commercial structure of the 1980s, but now they were coming into their element.