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Journal Article


The NHS Revolution: Health Care in the Market Place—Competition in General Practice

The Issue

In 2004, the U.K. government linked up to 20 percent of a general practice’s income to certain activities related to the quality of care. Other policy reforms being considered at that time would use market-based solutions to promote competition among National Health Service providers. In this Commonwealth Fund–supported study, researchers speculate on the effect that competition for services is likely to have on general practitioners in the United Kingdom.

What the Study Found

The authors proposed that greater competition might result in the commercialization of practices, mergers of existing practices, the linking of primary care services to hospitals, or the targeting of services to specific populations or conditions. Such activities could lead to more patient-centered care—since practices may be more likely to prolong office hours or provide a greater range of services. On the other hand, they could also lead to more-fragmented, less-equitable care delivery. Competition may also promote quality improvement, though it will not necessarily lead to greater efficiency.


The authors conclude that "exposing general practice to greater market forces is likely to result in some advantages and some risks for patient care."

Publication Details



M. Marshall and T. Wilson, "The NHS Revolution: Health Care in the Market Place—Competition in General Practice," BMJ, Nov. 19, 2005 331(7526):1196–99.