Intended for healthcare professionals


Community development, user involvement, and primary health care

BMJ 1999; 318 doi: (Published 20 March 1999) Cite this as: BMJ 1999;318:749

Community development has much to offer to primary care groups

  1. Brian Fisher, General practitioner (,
  2. Hilary Neve, General practitioner,
  3. Zoe Heritage, Freelance advisor on community development in health
  1. Wells Park Practice, London SE26 6JQ
  2. St Levan Surgery, Plymouth PL2 1JR
  3. 13 Rue du Scorff, 35700 Rennes, France

    The new primary care groups (local health groups in Wales) will need to shape services, assess health needs, reduce health inequalities, listen to users' views, and work in partnership with local agencies. This will require a range of skills which few primary health professionals currently have.1 Few fundholders undertook any health needs assessment or involved patients in purchasing,2 and the government has provided little conceptual, managerial, or financial infrastructure for public involvement. Public meetings are the only mechanism for consultation mentioned in the white paper—yet these are an inadequate means of genuinely engaging communities in the health issues that matter to them, particularly for marginalised groups. One solution is for primary care to work with community development projects, which have been tackling these issues for years.

    Community development recognises the social, economic, and environmental causes of ill health and links user involvement and commissioning to improve health and reduce inequalities. Communities can be geographical—such as particular housing estates—or communities of interest, such as user groups. Trained community development workers bring local people together to:

    • identify and support …

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