Following devolution, Scotland phased out GP fundholding and encouraged
cooperation and integration. It reduced the number of Scottish trusts through
mergers, which, from 2004, were eventually absorbed by newly established
health boards. Similarly, post-devolution Wales abolished GP fundholding,
and instead introduced local health boards (LHBs) in 2004. Local health
boards collaborated with NHS trusts to provide secondary and community
care; they also managed primary care. A continuing purchaser-provider split
was eliminated in 2009 through the creation of a smaller number of larger
local health boards that were made responsible for planning and delivering all
services based on geographical boundaries.
Northern Ireland, from 1972 to devolution in 2007, had a slightly different
structure in its health care system. Similar to other parts of the United Kingdom
at the time, purchasing took place according to geographical boundaries, as a
consequence of United Kingdom-wide changes in the 1970s. Purchasing bodies
included health and social care trusts, the Ambulance Trust, four commissioning
boards, and four Health and Social Care councils. A purchaser-provider split
has therefore been maintained in Northern Ireland. The Health and Social Care
(Reform) Act (NI) 2009 sought to streamline this organizational structure, and
to shift more funding away from health care administration to health care
services. As part of a general revision of administrative structures in the public
sector in Northern Ireland, the Reform Act reorganized the many small trusts