Table Of ContentPRIMARY CARE DEVELOPMENT
Extending
Primary Care
polyclinics
resource centres
hospitals-at-home
Edited by Pat Gordon
and Janet Hadley
Foreword by Barbara Stocking
Regional Director
Anglia & Oxford Regional Health Authority
Series Editors Pat Gordon and Diane Plamping
Published in association with King's Fund, London
CRC Press
Taylor & Francis Group
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
First published 1996 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 1996 Pat Gordon and Janet Hadley
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-85775-029-4 (pbk)
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Extending primary care: polyclinics, resource centres, hospitals-at-home/edited
by Pat Gordon and Janet Hadley.
p. cm.
Includes bibliographical references and index.
ISBN 1-85775-029-2
1. Primary health care-Great Britain. 2. Community health services-
Great Britain. I. Gordon, Pat. II. Hadley, Janet.
RA395.G6E93 1996
362.1'0941-dc20 95-47755
CIP
Typeset by Marksbury Multimedia Ltd
Contents
Series introduction V
List of contributors Vil
Foreword Vlll
Acknowledgements X
Introduction Xll
1 Prima health care -its characteristics
ry
and potential Pat Gordon and Diane Plamping
Introduction 1
Characteristics 2
General practice development 5
Community health services development 8
Some faulty assumptions 13
A health service guided by primary care? l 5
2 Boundaries in prima health care 1 7
ry
Julian Pratt and Liz Adamson
Introduction 17
Understanding the boundaries 18
Working the boundaries - specialist service in
the community 27
Conclusion 34
iii
Extending primary care
3 Primary care resource centres - a means of
supporting general practice?
Jillian Alderwick, Sarah Taylor and Maggie Jee 37
Introduction 37
The development of a primary care resource
centre in Birmingham 40
Service models for a primary care resource
centre in Birmingham 48
A resource centre without walls 52
4 Polyclinics - an alternative to practice-based
care? Franklin Apfel and Pearl Brown 63
Introduction 63
Polyclinics and urgent care centres 64
The polyclinic system in the Czech Republic 67
Urgent care centres in California 68
South Westminster Centre for Health, London 71
Conclusion 77
5 Hospital care at home Liz Haggard and
Egbert Bosma 79
Introduction 79
Hospital-at-home 82
Home care innovation: a development agency
approach 93
Summary 97
References 99
Index 107
IV
Series introduction
Primary care development is arguably the most important
topic for the NHS to get to grips with in the rapidly changing
environment of the 1990s. This new series of books about
primary care development is intended to be topical, useful and,
before very long, out-of-date. It is based on the current work of
the King's Fund Primary Care Group and the ideas, exper-
ience and inspiration of a number of people who have worked
with us and shared their enthusiasms.
Primary care is often used to mean general practice. Here it
is used in the broader sense to include the network of
community-based health services which in the UK allow us
to manage 90% of care outside hospitals; to manage earlier,
safer discharge from hospitals, and to maintain people at home
who do not want to be institutionalized.
From a position of relative neglect and invisibility, primary
care has shot to the top of the NHS policy agenda. This has
much to do with the NHS reforms and the drive to control
public spending. Like all industrialized nations faced with
ever-increasing costs in health care, we are experimenting with
reorganization. Since hospitals use most NHS resources, this is
where most attention is directed and primary care became
the focus only as a potentially cheaper option. But the drive
for efficiency and value for money coincides with other power-
ful influences which challenge us to examine alternatives to
Extending primary care
traditional ways of delivering services. If effective primary care
really is the key to successful health services in the future, then
recognizing its distinctive characteristics, and what we value
about it as well as what we want to change becomes critical.
This new series is about ideas and services which are being
developed and tested around the country. It is about work-in-
progress in a period of extraordinary change. Extending primary
care: polyclinics, resource centres, hospitals-at-home is the fourth title
in the series. It discusses ways of extending the capacity of
primary care to deliver the type of community-based services
on which so much attention is now focused. Other titles in the
series look at new ideas about the role of the practitioner,
experiments in new kinds of primary care organizations, and
new ways of managing practice-based primary care. We hope
the ideas in these books contribute to the debate about the
future shape of the NHS and are useful to the people working
now in the middle of these major changes.
Pat Gordon
Diane Plamping
King's Fund
London
February 1996
VI
List of contributors
Liz Adamson, Consultant Paediatrician and Medical Director,
South Derbyshire Community Health Services NHS Trust
Jillian Alderwick, formerly Director of Primary Care, Birming-
ham FHSA
Franklin Apfel, Visiting Fellow, King's Fund, London
Egbert Bosma, Director, Institute for Quality and Applied
Home Care Innovation (KITTZ), Groningen, Netherlands
Pearl Brown, Chief Executive, Riverside Community Health
Care Trust, London
Pat Gordon, Director of Primary Care, King's Fund, London
Liz Haggard, Director of Health, Office of Public Management
and formerly Chief Executive, South Derbyshire Community
Health Services NHS Trust
Maggie Jee, Independent Consultant and Researcher in Health
Care, London
Diane Plamping, Fellow in Primary Care, King's Fund,
London
Julian Pratt, General Practitioner, Sheffield
Sarah Taylor, Consultant in Public Health Medicine, Birming-
ham Health Authority
VII
Foreword
Fundamental changes in the Health Service demand a radical
shift in approaches to patient care. The NHS is becoming
increasingly led by the primary care sector. This has a greater
meaning than simply more involvement of GPs in secondary
care purchasing. It means that we start from where the patient
is, in their own home and community. We provide care for
them there and only move them into secondary services if and
when it is appropriate to do so.
We need then to do a great deal more thinking and experi-
menting about what is appropriate in primary care. We need
to develop the ability of those in primary care to deliver new
services as well as helping them to develop their skills as
decision makers in the use of and purchasing of secondary
services.
This book is about developing and understanding primary
care itself. It describes some current innovations - polyclinics,
resource centres, hospitals-at-home. If developing primary care
is to be about more than just relocating services from one place
to another we need to be clear how these developments are
different and whether they are cost-effective. Do they allow
patients and carers to have a greater sense of control about
what is happening to them; can we produce better patient
outcomes by delivering care closer to patients; do we find in
these experiments that we are extending the skills and capacity
of the primary care team; and finally what does it cost?
VIII
Foreword
These changes to shift care from the secondary setting to
primary care have proved difficult to achieve. There are par-
ticular difficulties in our major cities and their outer rings.
Extending Primary Care shows that it is possible to experiment
beyond traditional boundaries in these areas. It will provide
encouragement to people who work in these difficult settings by
showing what can be done. With the new combined health
authorities coming into effect in April 1996 this book could not
be more timely as a resource for those who need to extend their
understanding of primary care - in the fullest sense of the whole
team of people in general practice and the associated
community health services.
Barbara Stocking
Regional Director
Anglia & Oxford Regional Health Authority
January 1996
IX
