Book reviews

Abstract

Health ExpectationsVolume 3, Issue 3 p. 220-221 Open Access Book reviews Edited by Mark SculpherDemanding Patients? Analysing the Use of Primary Care By Anne Rogers, Karen Hassell and Gerry Nicolas. Open University Press, Buckingham. 1999, £16.99 (PB), £50 (HB), 272 pp. ISBN 0335 20090 7 (PB), 0335 20091 5 (HB) First published: 25 December 2001 https://doi.org/10.1046/j.1369-6513.2000.0077a.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Any publicly funded health system must live with a gap between what people may want from it and what that system can supply. Up to now most countries have tried to manage that gap by improving the way in which the resources devoted to health care are used. This book takes as its starting point the need to shift the emphasis towards managing the demands that individuals place on services. As in the UK most people’s first contact with the health service is the general practitioner (GP) or other professionals in primary care, such as community pharmacists, most of the book is concerned with this or with the alternatives such as self and lay care. Although the book calls on a wide range of literature, much of the text is based on the results of a user survey. This combines health diaries and interviews and was designed to shed light on the factors bearing on the decision to make use of health services. Use of primary care as measured by GP consultations continues to rise at a rate which cannot be explained – or more precisely, has not been explained – in terms of demographic shift or morbidity. The authors do not attempt to explain this rise in quantitative terms. Rather, they discuss this phenomenon from a number of different angles. The book begins by discussing those tricky topics: needs and (inappropriate) demand. It next reviews the various models which have aimed to provide a framework for research into, and description of, the way users decide to make use of services, such as the health belief model. It goes on to present a wide range of empirical material, including the findings of their own survey, bearing on the factors which determine whether people will manage their own (perceived) illness including their social networks and the information people have available to them. Again drawing on the survey findings, it takes community pharmacy as a case study. The final chapter draws some very broad policy conclusions. As the final chapter indicates, if demand management is to be taken seriously, there is a great deal still to be done. The determinants of the individual’s decision to seek professional help are far from being fully understood. Indeed, given the range and nature of the factors at work, such understanding may prove elusive – as this final chapter makes clear. Moreover, as the recent public health white paper1 acknowledged, with its announcement of the Expert Patient programme, the services that ‘demanding patients’ may be seeking may not form part of what is currently on offer. This leads to another fundamental task, that of rethinking the way that services are provided and the nature of the professional role. This vast agenda serves to emphasize the wide range of issues, which need to be considered once demand management is taken seriously. Most gain a mention in the book but many, such as the potential of telephone advice lines including NHS Direct or personal attitudes to risk, are only touched on and their scope and potential importance are not seriously assessed. Furthermore, since this book was published, the government has announced the establishment of ‘walk-in centres’ which are designed to make access easier, allowing more needs to express themselves as demands, the precise opposite of the central message of this book. Hence, this book represents a far from comprehensive treatment of the issues. Yet, anyone accepting that there must be a shift in emphasis in policy away from cost control to demand management will find this book an excellent starting point, not simply for the empirical material it contains from the user survey, but also for the consistently high level of reflection on what the results mean. Anthony Harrison, King’s Fund, London References 1 Department of Health. Saving Lives: Our Healthier Nation. London: Stationery Office, 1999. Google Scholar Volume3, Issue3September 2000Pages 220-221 ReferencesRelatedInformation