Abstract
Abstract The introduction of an internal market in health care in the United Kingdom has created a structured relationship, defined by contracts, between health care providers, such as NHS hospitals, and purchasers, such as general practitioner fundholders. Similar relationships are developing within hospitals between clinical directorates and support service departments, such as pharmacy. A 1993/4 interview survey, conducted at eight hospitals, obtained the views of 129 pharmacy, nursing, medical and managerial staff on pharmacy service development and management in this new environment. Contracts between pharmacy and clinical directorates were in place in only two of the hospitals. Where contracts existed, pharmacy managers viewed them positively but they acknowledged the resultant managerial challenges. Most pharmacy managers at sites without contracts were threatened by the prospect of them. In contrast, non-pharmacy staff welcomed contracts as an opportunity to define their service requirements. For most managers of support services such as pharmacy, the implementation of the internal market will present challenges. Managers will need to become familiar with their customers' needs using information from several sources, including pharmacists working within directorates. Then efforts will have to be made to negotiate contracts that meet those needs while permitting the further development of staff and services.
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