PCT perspective: primary care is more than health.

Abstract

Visionaries are not always popular. They challenge the status quo. Lord Darzi's clear vision is that primary care is more than health care. To somebody from a social care background that is music to the ears. Too often primary care has been seen as the exclusive prerogative of health. Indeed the editor in chief, theme editors, associate editors and editorial board members of this new journal are eloquent testimony to the medicalisation of primary care. The mish mash of life problems which come to the GPs surgery – to adopt the editor's phrase – may be housing related, may need social care services, or self-help groups to support the individuals. Sometimes of course they need medical help but they also need a system which is also able to address these other problems without an endless trail of referral letters to other agencies. The vision set out by Lord Darzi is appealing but how can it best be realised? The traditional response of politicians has been to seek structural solutions. The NHS has suffered at the hands of successive reorganisations which create discontinuity in the personal relationships which are essential for the delivery of partnership working. The chaotic introduction of PCTs means that only now six years on are they in a position to meet some of the wildly ambitious expectations set for them. Achieving those expectations means that patient experience has to be given a higher weighting than it has had hitherto despite countless ministerial speeches asserting patients first. The saga of mixed sex accommodation is salutary. What Ministers and hospital managers construe as single sex accommodation is not what patients mean. Until adjustments are made to management thinking this issue will continue to rank high on the list of patient grievances, rendered more acute because of the much trumpeted commitment to eliminate mixed wards.