TY - JOUR T1 - Funding deficits, finding gifts JF - British Journal of General Practice JO - Br J Gen Pract SP - 478 LP - 479 VL - 54 IS - 503 AU - Paul Hodgkin Y1 - 2004/06/01 UR - http://bjgp.org/content/54/503/478.abstract N2 - IT'S easy to think that money rules the world and some times it does. But NHS money often seems curiously unreal. Like a drunk we stagger from one annual funding crisis to the next, drinking each watering hole dry, but never quite being called to account.Despite appearances however, money does not count for everything in the NHS. Maintaining the give and take between organisations is often more important in the long run than the current financial position. And ‘must do's’ just have to be done regardless of the deficit. So, along with the usual market economy the NHS also runs a barter economy and a centrally planned, must do, economy. Barter and centrally planned economies govern relationships between organisations at local and national level respectively whereas markets are the national aggregate of individual decisions. Least known, and most interesting are gift economies that are governed by individual decisions made locally or across groups who know each other.In market economies the flow of goods is determined by the sum of individual decisions acting according to nationally defined rules. In the NHS the new financial flows regime and the future of foundation trusts all turn in large measure on market mechanisms. Markets within the public sector are zero sum — more hip replacements here means less chiropody there.Because market mechanisms are so familiar, everyone tends to assume that the market/consumer model is the gold standard most likely to deliver quality to consumers. In fact, the place for markets is strictly limited within health care, not least because the ‘goods’ are usually not at all good — unlike a Rolls Royce its always better not to own a radical colectomy. … ER -