Five: Local dynamic reform in the NHS since 2000

This chapter reviews research on the introduction of patient choice and competition (alongside the introduction of PbR) and the reorganisation of PPI systems within the NHS. It examines the Quality and Outcomes Framework and the conflicts presented between clinical evidence and increased patient choice. The chapter also makes a comparison of the internal market of the 1990s with the mixed economy of care of the 2000s and looks at lessons from public and patient involvement programmes in the 2000s.

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