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Rapid Responses: Rapid Responses published:
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Disintegration and Fragmentation
- Peter G Davies (24 April 2007)
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Re: Disintegration and Fragmentation
- Maria Gough (27 April 2007)
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Peter G Davies, GP Principal Keighley Road Surgery, Illingworth, Halifax. HX2 9LL
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The trend in NHS primary care has been towards disintegration and fragmentation. We see stand apart facilities such as walk in centres and NHS direct, being opened. We see out of hours work split from day time work. We see the ambulance service kept thoroughly apart from general practice. We see A+E departments not integrated with primary care provision. We know that primary care works best when it provides continuity of care for defined populations. (1) We know from Barbara Starfield's work that health systems with a strong primary care orientation reduce mortality, and costs in their areas. (2) Yet since 1997 we have seen a government set on making life harder for existing practices, and on doing virtually anything other than strengthen existing practices. As Salisbury (3) describes NHS centres have not added much to primary care provision. They have taken resources that could have developed and improved existing surgeries. This finding is part of a larger pattern. Rather than developing existing hospitals the government prefers alternatives such as independent sector treatment centres. Rather than develop existing NHS computer systems the government prefers to develop something entirely new, and with only token clinical engagement. The value of such initiatives is under question (4) Much NHS money is being wasted on innovations that duplicate existing services, rather than develop existing services. In a cash limited service this duplication is wasteful, damaging existing services without securing viable alternatives. Ever more fragmentation and disorganisation is emerging from this policy, and NHS walk in centres are a prime example of this destructive tendency. 1. Tudor-Hart, J.T. (1987) A New Kind of Doctor, Merlin Press, London 2. James Macinko, Barbara Starfield, and Leiyu Shi (2003) The Contribution of Primary Care Systems to Health Outcomes within Organization for Economic Cooperation and Development (OECD)Countries, 1970–1998 HSR: Health Services Research 38:3 ( June 2003) 831- 865 3. Salisbury, C (2007) NHS walk-in centres BMJ 2007; 334: 808-809 [Full text] 4. Cross, M (2007) Benefits of £12bn IT programme in NHS are "unclear," MPs say BMJ 2007;334:815, Competing interests: None declared |
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Maria Gough, Senior Nurse Practitioner Harlow WIC CM20 1QO
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I see that Walk in Centres (WIC) continue to serve their most important function: that of Scapegoat for the medical profession. Indeed, it must be most irritating to the medical profession that, despite 'scientific' evidence to the contrary - the British public continue to find whatever it is they seek in a nurse-led WIC and not their GP surgery. However, in defence of our medical colleagues, they have had a particularly bad decade: various scandals and their subsequent fall from grace has obviously had its effect and if projecting their professional anxieties in the direction of WICs makes them feel better about themselves - this is quite understandable. But consider the alternative: if WICs disappear, the spectre of professional accountability will arise and require exorcism......so be careful what you wish for. Competing interests: WIC Senior Nurse Practitioner |
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