This paper supports the desire of the UK Government to introduce to the National Health Service the concept of accountability for expenditure. General practice budgets will, for the first time, allow GPs, as purchasers of care, to define the needs of their patients and to arrange for those needs to be met, circumventing the arbitrary limits imposed on providers of care under the present arrangements. Should overspending of budgets occur, other doctors will review the decisions made. If the decisions are supported then it will be clear that the budget was insufficient rather than that the practitioner was profligate. The reverse might apply, but such peer review should not be unwelcome. Budgetary control will allow greater choice for the GP of the nature of 2° care provided for his patients. Trust between doctor and patient need not be undermined — indeed, patients may be more confident that they will not be exposed to inappropriate medical intervention. The responsibilities conferred by GP budgets should be accepted, the opportunities welcomed.
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