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50 Nurses and nursing: in£uencing policy The policy context The health service reforms of the 1990s were hailed as a radical rethink of healthcare. The creation of the internal market was intended to overcome the financial problems inherent in the NHS by focusing on efficiency and effectiveness. 1 Most of those involved found it created competition and hostility between NHS trusts, health authorities and individual GP practices. 3 Providers were forced to change and improve services in order to ensure GPs continued to purchase them.

In England, nurses have up to two seats on the board of a PCG. The three key functions of a PCG are: . to improve the health of the local population . to commission healthcare services . to develop primary and community care. In April 1999, PCGs replaced the GP fundholding scheme. PCGs involve groups of practices working together, covering a geographically defined area. They are to build on the successes of fundholding, locality commissioning, and total purchasing projects and other local commissioning schemes.

Public Health Alliance, Birmingham. ’ Lance Gardner The Primary Care Act Pilot sites were the result of a major rethink by the Conservative government on how primary care was to be organised and delivered in the future. In June 1996, the then Secretary of State for Health, Stephen Dorrell, undertook what became widely known as the ‘listening exercise’. In a period when primary care was facing increasing demands from patients and low morale among staff as well as recruitment problems, Mr Dorrell realised that something fairly radical needed to be done if primary care was going to lead the NHS into the next millennium.