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The NHS internal market offers community nurses unprecedented opportunity to achieve, through influencing the purchasing process, real improvements in health and health care. Shirley Goodwin outlines what she, as a purchaser, looks for when she commissions community nursing services.

The extension of GP fundholding and the focus on the primary health care team means that GPs have become major players in the purchasing of child and family community nursing services. Shirley Goodwin explores what effective purchasing by GP fundholders of health visiting services might entail and the principles which should inform their decisions.

Shirley Goodwin argues that the policy objectives of The health of the nation are broadly those of community nursing's own agenda. In particular, health visitors' skills in profiling community health needs should be invaluable to the new 'purchasers' of local health services--if they can be persuaded to recognise their value.

Shirley Goodwin outlines the evidence demonstrating the links between social deprivation and poor child health outcomes and the sorts of policies and interventions which might break them, with special reference to the provision of social support. She points out the challenges for health visitors and school nurses developing their work in this area in the context of the NHS reforms and the new systems for contracting services.