Prior to April 1990 FHSAs were mainly responsible for administering payments
to general practitioners, practice nurses, dentists, opticians, and pharmacies providing
primary care services. The reforms of 1990 expanded the tasks of FHSAs and
seem to have imposed an increasing administrative burden. The new GP contract
increased the range of activities for which GPs could claim payment from the
FHSA. FHSAs had an increased monitoring role and responsibility for improving
the quality of primary care by feeding back information to GPs and encouraging
peer review via Medical Audit Advisory Groups, which was compulsory for
practices after 1992 Fry, 1993 . From April 1991 practices were permitted to hold Ž .
budgets to spend on certain types of secondary care and on pharmaceuticals.