Abstract
National Health Service (NHS) reforms have sought to refocus the purpose of health care by shifting the provision and commissioning of health services from the secondary to the primary care sector (Department of Health and Social Security (DHSS) 1987, the NHS and Community Care Act 1990, Department of Health (DoH) 1989, 1992a). However, short termism in policy making has tended to create health care policies which are often unconnected and divergent in their implications (Williams et al 1993, Salter 1994). As a result, community nurses are having to manage such contradictions in a general management structure where access to professional leadership is increasingly elusive (Kitching 1993). This paper explores some of the impact of these reforms on the organisation of patient care and examines the role of community nurses within a primary care led NHS.
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