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March 13, 1996

Changes in Britain's Health Care: An American Attempts to Revisit 'From the London Post'

Author Affiliations

From the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, and Department of Surgery, New Hanover Regional Medical Center and Coastal Area Health Education Center, Wilmington, NC.

JAMA. 1996;275(10):789-793. doi:10.1001/jama.1996.03530340053029

NEARLY 50 years after its enactment, the National Health Service (NHS) in Great Britain is in abrupt and profound change. Four recent, major initiatives are inextricably interrelated. First, the general practitioner (GP) has become a fundholder, adding to his or her roles as caregiver and gatekeeper the additional and intrinsically contradictory roles of purchaser, actuary, accountant, and entrepreneur. Second, there is to be mandatory reduction of work hours of physicians in training to 56 hours or less per week. Third, shortening of specialist training is planned to bring British training into equivalency with that of the European community. Fourth, the former financial-administrative units and educational units (regions) are to be eliminated and replaced by fewer, presumably more efficient, units (trusts). Many British professionals consider these changes profoundly antithetical to the ethos of the NHS. Full implementation will have serious and unpredictable consequences for the delivery of health care and for