The Health service journal
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Primary care trusts are similar to US health maintenance organisations in that they act as both commissioners and providers of services. There are already innovative primary care organisations in the NHS and the private sector that can be classed as embryonic PCTs. Experience of these organisations, assessed in relation to HMOs, can inform the development of PCTs.
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The government has proposed a statutory scheme to regulate prices and profits on the sale of drugs to the NHS. Drug companies which don't cooperate could be liable to heavy fines, but the government has failed to spell out the precise conditions under which such penalties would apply. Defining what comprises excessive prices or profits is likely to present a number of empirical problems. Experience overseas suggests that the scheme will fail to halt the inexorable rise in the NHS drugs bill.
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The 1974 reorganisation of the NHS was the most radical to date. It abolished the involvement of local authorities in health, set up community health councils, introduced area health authorities and changed the management of family doctor services. The changes increased the power of hospitals.