Primary care: core values Developing primary care: gatekeeping, commissioning, and managed care

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Abstract
This is the fourth in a series of six articles reflecting on the core values that will underpin the development of primary care Series editor: Mike Pringle If Nye Bevan were around today, he might be surprised to find that the basic features of British general practice, not least its administrative separation from hospital care, are still in place half a century after the genesis of the NHS. But primary care has not stood still over that period—both its structure and role have developed continuously. This development has not been part of an orchestrated grand plan. Rather, it has been characterised by incremental change in response to wider pressures. In this article we examine briefly how some of these pressures have recently influenced the shape and direction of primary care in the UK, and reflect upon the direction of further change in future. #### Summary points Of the pressures outlined above, two of the greatest at present are the imperative to control the rising costs of health care and improve quality. Consequently, some of the prime movers shaping the development of health systems in the United Kingdom and other countries in recent years have been funders of health care, whether public or private. Three …