Intended for healthcare professionals


Improving access needs a whole systems approach

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:866

And will be important in averting crises in the millennium winter

  1. Anne Rogers, professor of the sociology of health care,
  2. Julian Flowers, consultant in public health medicine,
  3. David Pencheon, consultant in public health medicine
  1. National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL
  2. Institute of Public Health, University of Cambridge, Cambridge CB2 2SR

    A population that can do trivial things like shopping 24 hours a day in a variety of ways does not expect that doing serious things like accessing health care should be as difficult as it often is. Optimal access means providing the right service at the right time in the right place. Simplifying and improving access according to need is evident in recent initiatives by the British government, such as NHS Direct. Good access arrangements in the NHS will be central to averting crises in the millennium winter. Access should therefore be treated as part of a whole system of formal and informal care,1 ensuring that links are made within and between public services of all kinds. From this perspective there are many ways in which access can be improved.

    Firstly, ways of providing easier and more appropriate access to and between public services should be explored. Good access arrangements are vital at the interfaces of self and formal care and between primary and secondary care. Adoption of a whole systems approach in the winter of 1998-99 (involving better coordination between …

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