NHS Medical Trusts came into existence in 1990, the National Health Service & Community Care Act 1990 (in England) introduced an "internal market" into the NHS, whereby Health Authorities ceased to run hospitals directly but instead "purchased" care from their own or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients directly. The "providers" became independent trusts, which encouraged competition but also increased differences.