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We take the 2004 contract between British general practitioners and the government as an example of dilemmas that confront all European health systems. The contract allowed doctors to withdraw from out-of-hours coverage, but enabled commercial providers to enter the primary care market. Our research suggests that the doctors underestimated the threat of commercialization posed by these new contracts. Only after the consequences of the reform became clear they took policy positions against the commercialization which was facilitated by the contract they had agreed. This case is an illustrative example of the way that wage bargaining partners in the health service become involved in the structural maintenance of the system as well as the pay and conditions of their members, with possible trade-offs between the two.

The role of wage bargaining partners in public sector reform: The case of primary care contracts