▁decision ▁making ▁and ▁introduce ▁competition , ▁with ▁the ▁state ▁becoming ▁a ▁purch aser , ▁rather ▁than ▁a ▁provider , ▁of ▁w elf are ▁services . ▁▁ ▁The ▁setting ▁up ▁of ▁the ▁market ▁required ▁the ▁establishment ▁of ▁a ▁system ▁of ▁Pay ment ▁by ▁Results ▁and ▁the ▁form ulation ▁of ▁a ▁national ▁N HS ▁Tar iff ▁to ▁complement ▁the ▁fund ing ▁formula ▁de vised ▁by ▁the ▁Resource ▁Al location ▁Working ▁Party . ▁ ▁The ▁Tar iff ▁includes ▁a ▁weight ing ▁system , ▁the ▁market ▁forces ▁factor , ▁which ▁pays ▁prov iders ▁in ▁high ▁cost ▁areas ▁- ▁princip ally ▁in ▁London ▁- ▁en hanced ▁fe es . ▁ ▁In ▁ 2 0 1 9 ▁it ▁was ▁decided ▁to ▁reduce ▁the ▁London ▁weight ing . ▁ ▁The ▁internal ▁market ▁initially ▁established ▁N HS ▁trust s , ▁in ▁five ▁annual ▁waves , ▁as ▁separate ▁bodies , ▁splitting ▁purch as ers ▁from ▁prov iders . ▁Until ▁they ▁became ▁trust s ▁the ▁providing ▁organis ations ▁were ▁called ▁directly ▁managed ▁units . ▁ ▁The ▁trust s ▁had ▁bo ards ▁with ▁non - exec ut ives , ▁analog ous ▁to ▁company ▁bo ards , ▁and ▁business ▁people ▁were ▁encourag ed ▁to ▁serve ▁on ▁the ▁bo ards . ▁ ▁The ▁Act ▁also ▁established ▁GP ▁Fund hold ing , ▁a ▁scheme ▁where by ▁individual ▁GP ▁practices ▁could ▁take ▁over ▁the ▁management ▁of ▁hospital ▁services ▁for ▁their ▁patients . ▁ ▁Fund hold ing ▁was ▁abol ished ▁by ▁the ▁Labour ▁Government ▁in ▁ 1 9 9 7 / 8 . ▁The ▁Labour ▁Party ▁had ▁campaign ed