Planning and managing primary care services: lessons from the NHS in England

It is generally agreed that access to high-quality primary care is vital in the quest to provide the best possible health care at the lowest cost. Finding new ways to deliver and extend access to primary care services is of high priority in many health systems. The UK is no exception, and the past 30 years has seen a wide range of initiatives focused on primary care—particularly services provided by primary care physicians: GPs. Some initiatives have focused on payment models, altering contracts in an effort to change behaviour. Others have focused on the planning side, repeatedly enlarging, shrinking and reorganizing the organizations with responsibility for commissioning/purchasing primary care services on behalf of a population. In this paper we explore the latest of these policy and organizational changes, presenting the findings from an empirical study investigating recent changes to the commissioning of primary care services in England. Using an historical account of mechanisms to plan and manage GP services in England, we identify some of the issues involved. We explore the espoused logic underpinning the current reforms, and present early evidence about their implementation, highlighting the extent to which they may meet official aims and address the identified issues. The contribution offered is twofold:

  • First, we offer an account of the development of planning and management of GP services in England, bringing clarity to a complex field and providing valuable evidence for those responsible for overseeing primary care services in the UK and internationally.
  • Second, our exploration of the implementation of the latest round of reforms provides some lessons about the interplay between local, regional and national planning, and about the ways in which policy is made and implemented.

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