Two Modernising primary healthcare in England: the role of Primary Care Groups and Trusts
-
David Wilkin
Abstract
The National Health Service in Britain could not ensure that doctors … would choose overnight to be ‘better’ doctors; all it could do was to provide that particular framework of social resources within which potentially ‘better’ medicine might be more easily chosen and practiced. (Titmuss, quoted in Moon and North, 2000, p 72)
This chapter discusses how, some 40 years after Titmuss wrote the above, some of the last refuges of medical professional autonomy and individualism are being challenged. It describes the latest ‘framework of social resources’ – Primary Care Groups and Trusts (PCG/Ts) – and evaluates their prospects for success in, among other things, generating ‘better’ doctors (and nurses and other primary health professionals).
Historically, primary care – particularly the healthcare provided through general practitioners (GPs) – has constituted both the cornerstone and the Achilles heel of the National Health Service (NHS). Both as the provider of easily accessible, low cost, first contact and continuing care and as the gatekeeper to more expensive specialist health services, primary care has played a major role in ensuring universal healthcare is available in Great Britain, at relatively low cost. However, wide variations in the levels and standards of primary care services, difficulties in containing costs within a demand-led service, and the separation of primary care from mainstream NHS management and planning have together prevented the development of a service that is either of consistently high quality or integrated with other community-based health services. For the past 50 years, general practice has remained a ‘cottage industry’ on the fringes of the NHS, based on “individualistic, small shopkeeper principles” in which “the principles of free choice of doctors by patients and complete medical autonomy … remain sacrosanct” (Klein, 1983, p 14).
Abstract
The National Health Service in Britain could not ensure that doctors … would choose overnight to be ‘better’ doctors; all it could do was to provide that particular framework of social resources within which potentially ‘better’ medicine might be more easily chosen and practiced. (Titmuss, quoted in Moon and North, 2000, p 72)
This chapter discusses how, some 40 years after Titmuss wrote the above, some of the last refuges of medical professional autonomy and individualism are being challenged. It describes the latest ‘framework of social resources’ – Primary Care Groups and Trusts (PCG/Ts) – and evaluates their prospects for success in, among other things, generating ‘better’ doctors (and nurses and other primary health professionals).
Historically, primary care – particularly the healthcare provided through general practitioners (GPs) – has constituted both the cornerstone and the Achilles heel of the National Health Service (NHS). Both as the provider of easily accessible, low cost, first contact and continuing care and as the gatekeeper to more expensive specialist health services, primary care has played a major role in ensuring universal healthcare is available in Great Britain, at relatively low cost. However, wide variations in the levels and standards of primary care services, difficulties in containing costs within a demand-led service, and the separation of primary care from mainstream NHS management and planning have together prevented the development of a service that is either of consistently high quality or integrated with other community-based health services. For the past 50 years, general practice has remained a ‘cottage industry’ on the fringes of the NHS, based on “individualistic, small shopkeeper principles” in which “the principles of free choice of doctors by patients and complete medical autonomy … remain sacrosanct” (Klein, 1983, p 14).
Chapters in this book
- Front Matter i
- Contents iii
- Notes on contributors v
- The year in social policy 1
-
UK developments
- Modernising primary healthcare in England: the role of Primary Care Groups and Trusts 15
- Devolution in England: coping with post-industrial industrial regions – issues of territorial inequality 37
- Reconstituting social policy: the case of Northern Ireland 57
- ‘Revolutionising’ care for people with learning difficulties? The Labour government’s Learning Disabilities Strategy 85
-
International developments
- Globalisation and welfare: a meso-level analysis 107
- The ‘anti-globalisation’ movement and its implications for social policy 127
- Migration policy in Europe: contradictions and continuities 151
- The European Union’s social policy focus: from labour to welfare and constitutionalised rights? 171
-
Conceptual developments
- The politics and economics of disciplining an inclusive and exclusive society 199
- Green social welfare: an investigation into political attitudes towards ecological critiques and prescriptions concerning the welfare state 225
- Using social capital in the policy context: challenging the orthodoxy 249
- Participation and social policy: transformation, liberation or regulation? 265
- Index 291
Chapters in this book
- Front Matter i
- Contents iii
- Notes on contributors v
- The year in social policy 1
-
UK developments
- Modernising primary healthcare in England: the role of Primary Care Groups and Trusts 15
- Devolution in England: coping with post-industrial industrial regions – issues of territorial inequality 37
- Reconstituting social policy: the case of Northern Ireland 57
- ‘Revolutionising’ care for people with learning difficulties? The Labour government’s Learning Disabilities Strategy 85
-
International developments
- Globalisation and welfare: a meso-level analysis 107
- The ‘anti-globalisation’ movement and its implications for social policy 127
- Migration policy in Europe: contradictions and continuities 151
- The European Union’s social policy focus: from labour to welfare and constitutionalised rights? 171
-
Conceptual developments
- The politics and economics of disciplining an inclusive and exclusive society 199
- Green social welfare: an investigation into political attitudes towards ecological critiques and prescriptions concerning the welfare state 225
- Using social capital in the policy context: challenging the orthodoxy 249
- Participation and social policy: transformation, liberation or regulation? 265
- Index 291
