Is It Time To Scrap The Internal Market In The NHS?

The abolition of District and Regional Health Authorities led to the establishment of Primary Care Trusts who took over responsibility for buying care for their local population.

At that time there was a lot of talk about Patient Choice.  The idea was that patients would look at where they might have their treatment and choose the provider that would best fit their needs.

Over a decade later what is clear that the real choice patients wanted was wherever possible to go to their local hospital for treatment and an acceptance that for specialist services they may have to go further afield.

The recent move towards CCGs was the latest in a series of re-organisations aimed to put decisions about health services as local as possible.

While the intentions might well have been good, the question I would have now is whether it’s time to scrap the internal market.

While it might be bringing some benefits, this set up comes at a cost.

Thousands of hours of manpower are spent negotiating and agreeing contracts.  Thousands more are spent reviewing performance against service level agreements, arguing about validity of data and the likes.  On the other hand does it radically change what is purchased or make any significant difference to quality?


It creates silos where it is easy for one part of the system to blame another when things are not going well.  A&E is a classic example of this.


It discourages team working between different organisations and even within organisations.


It makes it impossible to see where real accountability lies.


It costs a lot to administer both in commissioning and provider organisations.


While an end to the internal market would not necessarily lead to a perfect system it may well have a positive impact in working together to solve problems rather than time and energy being spent in what is often unhealthy conflict.

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