Primary care: choice and opportunity

Letting a thousand flowers bloom to promote the primary care led NHS

Last week saw the launch by the British government of yet another white paper on primary care1 as a prelude to another new law. Those in the front line of the health service can be forgiven for reflex alarm; we seem to have been here before. But this time seems to be genuinely different. This white paper comes after the “listening process”2 and distils ideas presented to the Department of Health and the NHS Executive by professionals on the ground. And for the first time it is not them telling us that ‘mother knows best’. It is more a confession that rigidities have been imposed in the past that have inhibited our capacity to function effectively.

In essence Choice and Opportunity creates the capability for the NHS to sanction and evaluate experiments in primary care that are designed to improve both sides of the cost-effectiveness equation. General practices can choose to continue as at present. But those who find that current contracts and regulations inhibit the changes they want to make, will be helped and even encouraged to test their ideas. In theory this should unleash general practitioners' imaginations and exploit their innate capacity for innovation, creating a market place of ideas and excellence through …