Education And Debate

Primary care: opportunities and threats: what the changes mean

BMJ 1997; 314 doi: (Published 08 February 1997) Cite this as: BMJ 1997;314:436
  1. Trish Groves, assistant editora
  1. a BMJ London WC1H 9JR


    Primary care in Britain could change considerably from 1998. Now, the first contact with the NHS for most patients is through one of a handful of independently contracted partners in a small, local general practice surgery. From next year a wide range of pilot schemes in each district might offer patients something radically different: primary care from a salaried general practitioner in a large unit run by an NHS trust or other provider. These and other big changes in primary care look set to be piloted, even if the government is replaced this spring. This series of six articles will debate the opportunities and threats to the NHS posed by these latest plans.

    After seeing your general practitioner, having an hour's session of physiotherapy, and getting your eyes tested you might make a dental appointment–all without leaving the primary care centre. The following week you could go to your local big pharmacy store to buy some shampoo, drop in your holiday photographs for processing, see the asthma nurse, and then collect your medicines. Many of us in Britain are used to one stop shopping; we could soon be getting one stop primary health care, or even a combination of the two.

    Opening up the primary care market to new providers–including NHS trusts and private health-care providers as well as other commercial companies–is just one of the British government's latest ideas for reforming the NHS. The proposal appears in Choice and Opportunity (box),1 a white paper published at the end of last year to put flesh on the bones of the primary care bill that is currently going through parliament. Two other white papers have followed, one of which also relates specifically to primary care (box).2 The other is a general mission statement for the whole NHS that does …

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