If properly implemented, the government's recent white paper on health and social care, Our Health, Our Care, Our Say: a new direction for community services, will be, in my view, a landmark document that will affect the future of every patient in this country.
Its impact will be felt quickly, and it has the potential to transform the landscape of healthcare in England. It is radical in suggesting a reshaping of the NHS by moving resources and activity out of hospitals and into primary care, giving patients a louder voice, taking special measures in deprived areas and promoting patient choice.
So how should primary care managers react to this?
We will have failed if we are complacent and resistant to change. My message to managers is: declare your ambition for primary care. We need creative and inspirational management to bring about a step change in primary care development. This is the key to harnessing the opportunities presented by the white paper – practice-based commissioning (PbC), new contractual models and different ways of working.
We all know that some things need to be done differently. Patients face fragmentation of care and dysfunctional communication. There are obvious opportunities to put things right – with primary care at the heart of the NHS.
Most patients' contact with the NHS is through their GP practice. GPs and practice nurses undertake the lion's share of the work of the NHS. Some 259 million consultations took place with GPs in 2003. More than 90% of healthcare problems are dealt with in primary care, and most patients will consult their GP at least once a year. Patients with chronic disease management receive good clinical management and organised care. GP services are among the most patient-centred and personalised in the NHS.
But these are uncertain times for primary care, particularly with the changes anticipated in budgets. It is essential that managers grasp the nettle now and plan ahead. The challenge is how to deliver and improve patient care in a resource-challenged environment. The key to unlocking this is (a) to work with patients, and (b) to collaborate with other practices.
In conclusion, I would like each practice manager to consider doing three things: