The "internal market" was created after the 1987 UK general election focused attention on inadequate funding in the NHS, long waiting lists for elective surgery, and large unwarranted variations in clinical care.

Economists attributed these problems to a lack of incentives for efficiency, and the remedies offered included increasing competition in the NHS.

Twenty nine years later, this interesting experiment is not likely to have been worth it, says Alan Maynard, professor emeritus of health economics at the University of York. But Michael Dixon, a GP and commissioner in Devon, says that if properly funded and liberated from some of the administrative burdens of "red tape," the internal market could increase accountability.

Read their full debate:
http://www.bmj.com/content/354/bmj.i3825