Community-oriented primary care—old wine in new bottles

Abstract

The successful delivery of primary care in the UK increasingly requires skills in strategic planning, needs assessment and service evaluation. With the evolution of the general practitioner's purchasing role, new educational models are needed. Community-Oriented Primary Care (COX) is one approach to the integration in practice of public health and primary care. The aim of this study was to evaluate the King's Fund's COX programme in terms of its impact on practice teams, patient outcomes and costs as compared with benefits. Fifty two semi-structured interviews were undertaken in six general practices and two urban district health authorities involved in the programme. A detailed costing of the project was undertaken. The benefits required to offset costs were compared with the results of practice-based project evaluations where possible. Primary health care teams were able to make a community diagnosis and identified problems on which to take action. Individuals learnt new skills, e.g. in data analysis, computing and behavioural change techniques. All practices recorded benefits to patients, though these were difficult to assess. In jive practices, new services were established. The cost-effectiveness of Copc in practices seeking to reduce cigarette smoking compared favourably with other interventions in this area. Copc does not provide a radically new way of delivering health services. It can be used to complement other initiatives that seek to develop the purchasing functions of general practices, to increase understanding of the factors influencing the health of practice populations and how to address them.