- This book - developed from a systematic review of evidence about the impact of the NHS internal market - asks what lessons can be learned from the internal market reforms, and how this knowledge can be used to aid policy-making in the future. It synthesises all the evidence on the impact of the three main elements of the 1991 reforms (health authority purchasing and local commissioning, GP fundholding and total purchasing, and NHS trusts) to answer the following questions: did the reforms improve health services or did they destroy the principles of the NHS?; how far did competition really occur?; what was the impact of the internal market on efficiency, equity, choice and responsiveness, quality and accountability?; and do the Labour government's plans for the NHS demonstrate that lessons have been learned from the experience? The book also shows how research can be improved to help decision-making in the future.