What is primary care? Developments in Britain since the 1960s

Abstract

Since 1994, health policy in the UK has focused explicitly on making the NHS 'primary care-led'. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care.

New roles and relationships in the NHS – barriers to change

“…All the White Papers have been questioned for their assumptions of a key strategic role for GPs. Historically, it is argued that there have been considerable difficulties in getting GPs to think and behave strategically (See Lewis, 1998aLewis, , 1998bToon, 1994). More recently, such an observation was also made in a study of the approaches being adopted by GP fundholders in Scotland (Farmer and Chesson, 1998).…”

“…They have given less prominence to other approaches to this role, which for example emphasise health promotion and screening, and patient interaction and communication (Toon, 1994). The role of other health care professionals has been marginalized as a consequence, creating tensions between them and GPs (Lewis, 1998a). Various government and professional initiatives have sought to encourage a wider perspective upon this role, although it has been noted that progress in achieving this has been slow (see Laing et al, 1996).…”

The Doctors' Dilemma: Issues for a Primary Care Led NHS

“…But the fundamental orientation of primary health care was not seriously disturbed; it was the sick who needed a doctor and primary care was for the sick, rather than the whole community. It was medical care, rather than health care in a broader sense (Lewis, 1998).…”