Economic Behaviour and the Contracting Outcome under the NHS Reforms: Theory and the Example of Community Nursing

Explores the problem of identifying efficient economic behaviour under the NHS reforms. It argues that “business‐like” behaviour by purchasers is unlikely to be economically efficient. However, discussion of more appropriate contracting behaviour tends to be blocked out by assumption because the roots of the reforms are in the economic theory of public choice and individual contracting. Drawing on a small scale research project on contracting for community nursing in one health authority, argues that the least economically damaging forms of contracting behaviour within the new NHS system may require producers to take a strong role in defining quality and responding to need, and that policy needs urgently to address the necessary organizational and cultural conditions for sustaining such behaviour.