The re-organisation of the NHS by the new coalition government will, as well as affecting all our lives, attract widespread international interest. Is it possible, in adverse financial circumstances, to sustain an almost wholly state-funded health service, and if so, how? This interest will be sharpened by the inclusion of an ‘outcomes framework’ as one of the central components of the recent government White Paper1 — the Quality and Outcomes Framework (QOF) for general practice has been a subject of intense international attention2 — together with a greatly increased emphasis on the role of GPs in commissioning services for patients.
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