Not a panacea for the problems faced by primary care

Over 9000 general practitioners, covering more than a third of the population of England and Wales, have opted to become fundholders.1 They have taken the responsibility for managing budgets for staff, premises, and prescribing and for some hospital and community health services. The remaining 21000 non-fundholding general practitioners are also taking greater responsibility for commissioning health services, either as part of commissioning groups or through locality purchasing. To become effective commissioners of health services, fundholding general practitioners will need skills in disciplines that are usually seen as the remit of public health specialists and health service planners, such as epidemiology, needs assessment, and health service planning. In short, fundholders are expected to take on many of the roles of district health authorities and family health services authorities but at a practice level.

The King's Fund has recently suggested community oriented primary care as one method of teaching and applying public health skills in a primary care setting.2 Originally developed in Israel, community oriented primary care has several requirements. These include a primary care practice based in the community; an identifiable population or community for which the practice assumes responsibility for improving its health status; a planning, monitoring, and evaluation process for identifying and resolving health problems; and liaison and collaboration with local community leaders.3 Readers might be forgiven for mistaking this as a description of the work done by their local health authority (which to all intents and purposes it is).

Community oriented primary care was started in Israel because of concerns about the lack of coordination of health …