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Medicine and Public Policy |

Commissioning Health Care in England: An Evolving Story

Norma O'Flynn, MB, BCh, BAO, PhD; and Jonathan Potter, DM
[+] Article and Author Information

From Royal College of Physicians, London, United Kingdom.


Disclaimer: This article represents the personal view of the authors and does not represent the official position of the Royal College of Physicians.

Potential Conflicts of Interest: Dr. O'Flynn is a part-time general practitioner with the National Health Service. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0092.

Requests for Single Reprints: Norma O'Flynn, MB, BCh, BAO, PhD, Clinical Director, National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, 11 St. Andrews Place, Regents Park, London NW1 4LE, United Kingdom.

Current Author Addresses: Dr. O'Flynn: National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, London, 11 St. Andrews Place, Regents Park, London NW1 4LE, United Kingdom.

Dr. Potter: Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 11 St. Andrews Place, Regents Park, London NW1 4LE, United Kingdom.

Author Contributions: Conception and design: N.O'Flynn, J. Potter.

Drafting of the article: N. O'Flynn, J. Potter.

Critical revision of the article for important intellectual content: N.O'Flynn, J. Potter.

Final approval of the article: N. O'Flynn, J. Potter.


Ann Intern Med. 2011;155(7):465-469. doi:10.7326/0003-4819-155-7-201110040-00009
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The general election in the United Kingdom in May 2010 resulted in the election of a new government, a coalition between Conservative and Liberal Democrat parties. Six weeks after the election, a white paper, “Equity and Excellence: Liberating the NHS,” that proposed profound changes to the structure and organization of the health service was published. The change that generated the most discussion was the proposal that general practitioners be placed at the center of the system and given control of about 80% of the National Health Service's £100 billion budget. The proposals were greeted with considerable concern by many health care professionals, patient representatives, and the media. In response, the government organized an independent review, and proposals have been altered in response. This article outlines the current organization of the National Health Service, the rationale for change, and government proposals.

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