The primacy of primary health care

General practice is unarguably one of the great strengths of British medicine, but the concept of the primacy of primary health care must be seen for what it is—another attempt at cost containment. The lunatic reorganisation of the NHS by Kenneth Clarke, which aimed to reduce costs by creating fundholding general practitioners and setting one hospital against another in spurious competition, was the primacy of management. It failed because it was manifestly unfair to patients, created strife between hospitals that had no spare capacity for proper competition, and spawned a huge increase in the management culture. The new reorganisation into supreme primary care groups, designed to be independent of hospital trusts, is unlikely to lead to much improvement, for it rests on the same premise—that cost can be controlled only by maintaining the conflict between purchaser and provider. District general hospitals dealing with several primary care groups will have just as many problems as they had when their purchasers comprised a mixture of fundholding practices …