In the NHS quasi-market, contracts are the crucial mechanism through which purchasers influence providers of health care. Most attention has been given to the commissioning and contracting process in acute hospital services. However, there is another important but neglected sector of health care -community health services (CHS) -in which the specification and implementation of contracts is particularly difficult. In this article, three dimensions of contracting are analysed, illustrated by qualitative evidence from case studies, concerning: the measurement of activity; the estimation of costs and prices; and the monitoring of outcomes and quality. This article argues that community health services are intrinsically problematic within the quasi-market, and suggests that the nature of the services and the system of delivery militate against provider competition. It is argued that CHS have more in common with 'clans' and 'networks' rather than markets and hierarchies, and that this requires collaborative rather than adversarial relationships between purchasers and providers.

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SummaryPoverty is strongly associated with mental illness. Access to state benefits can be a lifeline for people with mental health problems in times of hardship and can assist them on their journey of recovery. However, benefit application processes can discriminate against those with mental illness and can result in individuals unjustly missing out on support. Clinical evidence from mental health professionals can ameliorate these challenges and ensure that people get access to financial help.Declaration of interestDr Billy Boland is on the advisory board of the Money and Mental Health Policy Institute.

Purpose -This paper is aimed at telecare service providers and individuals who are aiming to manage the risks to a vulnerable person, who may be prone to becoming lost away from their own home. It aims to help them identify the issues that may be relevant in specifying the most appropriate GPS location device from the many models now on the market.Design/methodology/approach -The reported study is based on a comparison of six commercial devices with three different form characteristics. Technical measures of performance were undertaken in an objective manner for each device. These were considered along with the subjective views of a panel of stake-holders looking at issues such as usability, wearability and aesthetics in determining value for money and the optimum device for individual users.Findings -The work concluded that battery management was of vital importance, and that the use of geo-fencing for alarm purposes was often limited by the minimum practical size of the fence and by the way that it could be established.Originality/value -It is recommended that service providers employ a range of GPS devices within their inventories, so that they are not limited to one or two different devices when prescribing telecare services to people who are at risk of wandering, especially at night. The variation in cost between the most expensive and the cheapest can be justified in terms of service support and other options. These devices are most likely to be of benefit when used within a telecare service that can offer 24-hour monitoring and links to a dedicated emergency response team.

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This paperpresentsjndings from a study ofcontract specijkation and implementation in community health services (CHS). In this paper, we focus on one aspect of that study: the role of local people in informing the assessment o f health needs and in determining the provision of community health services in the context of the NHS "internal market". The paper is based on jieldwork undertaken in three districts within one region. Analysis of data obtained from these localities suggests that while there appears to be a genuine commitment to the principle of local involvement, ideas about how that involvement can be built into the activities of either purchasers or providers are less transparent.

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