Government vision for future of primary care right but making it a reality poses major challenges

The government's ambitious agenda to reform primary care services will fail unless the huge financial pressures facing the NHS are managed effectively and ministers introduce the right incentives to enable services to be delivered closer to people's homes.

That was the message from The King's Fund today in response to the government's White Paper on improving community health and care services. Speaking in response to Our health, our care, our say: a new direction in community services, The King's Fund chief executive Niall Dickson said:

'The White Paper offers an unprecedented opportunity to redesign community health and social care services. The government has outlined an ambitious agenda and we welcome the government's vision of shifting care from hospital settings into the community - this is long overdue. We also support measures to introduce more accessible, convenient services in local settings and better integrated care - particularly for patients with complex needs and long term conditions.

'But we must not underestimate the challenges ahead - we've been trying to do this for more than 30 years with limited results. And today's announcement has to be seen in the context of a health service that is struggling financially and finding it difficult to meet all the demands being placed on it.

'This is likely to be one of the rockiest years the NHS has faced and keeping the whole system going while encouraging local organisations to change the way they operate will not be easy. What is more, some of today's proposals designed to increase access to services may encourage more use by the worried well of scarce health resources.'

On strengthening commissioning

Commenting on government plans to give family doctors more responsibility for local health budgets, Niall Dickson said:

'Practice-based commissioning is crucial if the government's vision of shifting more care into the community is to be delivered. The White paper sends us in the right direction but we are concerned that there is not enough in the proposals to engage family doctors and encourage them to take more responsibility for budgets. Without the active support of family doctors these plans will fail. To achieve this we need the right balance between giving family doctors the freedom to innovate and rewarding them for this, while holding them to account for the services they provide.'

On allowing different providers to compete for services

Commenting on government plans to encourage more alternative providers in primary care, Niall Dickson said:

'For too long patients, particularly those in deprived areas, have been poorly served by community health services.

'Accordingly we support government moves to inject a degree of competition by opening the door to more alternative providers, including those from the voluntary sector. This will not mean a cut throat market but it should encourage new players to come in and provide services in areas where services are not delivering.'

On new NHS 'life checks'

Niall Dickson said: 'The government is right that the NHS should provide better prevention and earlier intervention. The new NHS 'life checks' could help to uncover serious illnesses, such as heart disease, before they deteriorate to a point where high-risk patients in particular need expensive and disruptive hospital treatment.

'But we do need to be cautious - there is a limited evidence base to suggest that MoT-style checks are a cost-effective way of targeting people most at risk of ill health. They could swallow up resources without delivering the benefits intended.'

Notes to editors: 

  1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.