Modernising primary and community health services

This is the second in a series of five articles

The government's plan for the NHS, published in July 2000, sets out an ambitious programme of investment, recognising that “the development of primary care services is key to the modernisation of the NHS.”1 Since the founding of the NHS primary care has been one of its greatest strengths but also its weakness. It has provided low cost, easily accessible care, but it has also been characterised by wide variability in quantity and quality, fragmentation, and a lack of coordination. The Labour government's 1997 white paper on the NHS proposed sweeping away the internal market and promoting a culture of collaboration and partnership.2

The establishment of primary care groups in England in 1999—which were charged with developing primary and community health services, commissioning hospital services, and improving the health of communities of around 100 000 people—represented a radical change in the organisation of primary and community health services. By 2004 all of these groups will become fully fledged primary care trusts, controlling most of the budget for providing health care to the populations that they serve. These organisations, led by local health professionals, will play a vital role in delivering the changes to primary and community services that the government sees as key to modernising the NHS. Within a framework of goals and performance standards set at the national level, the NHS plan asserts that the responsibility for decisions about services should be devolved to those who best understand local needs and circumstances.1 In this article, we focus on three key components of the government's strategy for modernising primary and community services: promoting a more efficient use of resources through collaboration and sharing, improving access to primary care, and enhancing the capacity of the workforce.