title: Can primary care be both patient-centred and community-led?
abstract: Examines the relationships between the macro-, meso-, and micro-levels in the NHS at the end of the fundholding period and considers their contemporary implications for primary care groups (PCGs) and local health care co-operatives (LHCCs). Fundholding achieved some success in challenging the way in which services were provided at the micro-level (the practice), but had a less marked effect in terms of changing service provision at the health authority (meso-) level or in developing collaborative working with trusts and health authorities in strategic decision making. The health authorities prioritized alternative models of devolved commissioning. Trusts regarded fundholders as a distraction who exerted influence and commanded trust management time disproportionate to their "market share". PCGs and LHCCs represent a shift back to the meso-level in service planning and purchasing. As such there is a risk that the micro-level benefits of fundholding and other forms of devolved commissioning will be lost, while uncertainties remain regarding the capacity of PCGs and LHCCs to incorporate GPs into a collaborative approach to strategic decision making.
authors.affiliation: Community Programme, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Drummond
authors.forename: S
authors.initials: S
authors.lastname: Iliffe
authors.forename: S
authors.initials: S
authors.lastname: McGregor
authors.forename: N
authors.initials: N
authors.lastname: Craig
authors.forename: M
authors.initials: M
authors.lastname: Fischbacher
mesh_terms: D018672:Community Health Planning / Q000458:organization & administration*; D003256:Community Participation; D003299:Cooperative Behavior; D003657:Decision Making; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012494:Sampling Studies; D012606:Scotland; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom