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Modernisation of primary care

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Primary care is currently in the throes of change with various initiatives under way that are transforming the provision and the form of services.

This process of change was accelerated in July of last year when former NHS chief executive Sir Nigel Crisp issued a letter to all health service managers known as Commissioning a Patient-Led NHS.

That letter announced a radical shift of primary care trusts from being providers of services to commissioners. It also outlined large-scale mergers of existing health service organisations.

One of the ideas behind Commissioning a Patient-Led NHS was to have PCTs contract out service provision to GPs, existing NHS bodies, foundation trusts, NHS staff setting up their own organisations, and the independent and voluntary sectors.

The involvement of the independent and voluntary sectors has proved to be controversial and many community nurses raised fears about who would be employing them and how their NHS employee status would be affected.

Some nurse representatives are worried the consequence of this will be the NHS becoming a logo or franchising badge as seen in fast food chains. In one case a strategic health authority proposed – for a time – that it would invite tenders for the provision of management services in the commissioning role for one of its newly reconfigured PCTs.

This idea, which was later dropped, would have meant a private sector company could not only provide ‘NHS’ services, but also make decisions about what services and what drugs were available - a scenario that most unions saw as privatisation of the NHS.

Following an outcry from staff and unions, the Department of Health backtracked and said PCTs would not automatically lose their role as providers of services if they wanted to keep that role. It also apologised for the lack of warning on such radical changes to come.

The mergers have resulted in England’s 28 strategic health authorities becoming just 10 in July 2006 and the country’s 303 PCTs will become 152 from October. This has meant many jobs have been ‘reconfigured’ and lost.

The government is also encouraging what it calls ‘entrepreneurial’ nurses to consider running primary care services themselves, but this is only likely to appeal to a small number of nurses with business skills.

After a major listening exercise with the general public carried out last year, the government published its White Paper Our health, our care, our say in January 2006 year, outlining a major drive to move care for patients closer to home.

It proposed longer GP practice opening hours; an improved role for community hospitals, more out-patient services in primary care; annual health MoTs; more self-care to be done by patients; more say for patients on local services; and a greater focus on primary care in mental health.

Updated: September 2006

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