NHS Purchaser–Provider Relationships in England and Wales: The View from Primary Care

Abstract

Abstract Primary care organizations (PCOs) in the National Health Service in England and Wales are required to purchase most hospital‐based health care for their populations. This ‘quasi‐market’ in health care can be seen as ‘relational’, characterized by an emphasis on cooperative long‐term relationships rather than on true competition. The English government has recently introduced new market mechanisms as a response to the perceived weakness of the relational market. This article draws on three qualitative case studies of PCOs to investigate whether PCO personnel interviewed in 2005/6 concurred with that perception of weakness. Overall, relationships between PCOs and hospital services providers were regarded as unbalanced in favour of the latter, despite a shared framework of central government policy. Commissioners were seen as generally weak, and providers were judged to be generally unresponsive to PCOs’ wishes. Top–down pressure by governments on PCOs and providers of hospital services was more important than commissioning power in shaping hospital services. It remains to be seen whether the remarketization strategy succeeds in strengthening the commissioning function in primary care.