Community care and general practice

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7009.823 (Published 30 September 1995) Cite this as: BMJ 1995;311:823
  1. David Kingdon,
  2. Sue Sumners
  1. Consultant psychiatrist Bassetlaw Hospital, Nottinghamshire S81 0BD
  2. General practitioner Stanmore, Middlesex HA7 NU

    General practitioners can identify need, provide information, and work with carers and managers

    Community care for people with problems of old age, mental illness, learning disability, and physical disability did not begin in Britain in 1993. But a lot of noise was made about it then. What did happen that year was a fundamental change in the system of funding residential and nursing homes. The 1990 NHS and Community Care Act devolved the prime responsibility for means tested funding from the central Department of Social Security to local social services departments. The act also replaced an open-ended and rapidly expanding budget with a limited budget based on individual assessments of needs.1

    There has been much apparent change and apprehension. Yet, after the second financial year, the debate on community care seems to have gone comparatively quiet. Has anything of substance actually changed? How well is the system working? Has “monitoring fatigue” set in?2 Has there really been enough money? Some local authorities have reported budgetary crises,3 but most have managed with the resources allocated to them, sometimes by tightening …

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