Total purchasing. Tracking down care.

Purchasers have a duty to monitor the quality of services purchased on patients' behalf; a purchasing general practice is best placed to do this effectively, especially by means of a tracker nurse. The tracker nurse should be diplomatic and experienced to earn the respect of professional staff in provider units, some of whom may see the process as threatening. The purchaser must introduce the concept of care monitoring gently but firmly, agreeing terms of confidentiality. Good practice should be highlighted and used as an example to others. Monitoring must follow the whole pathway of care, at the time and place it is given.