Key points
- Primary and community care services are usually the first level of contact between people and the NHS. Their purpose is to bring basic health care as close as possible to where people live and work.
- Recent policies have sought to strengthen the role of primary and community services by shifting the balance of care away from hospitals.
- Primary care includes GPs and practice nurses, as well as pharmacists, dentists and optometrists. A growing variety of other locally available care and treatment services are being developed, including walk-in-centres and polyclinics.
- Community care includes district nurses providing care for (mainly older) people in their own homes and residential care facilities, and health visitors who provide early intervention and health promotion to families with babies and/or young children. Community care also includes podiatry, speech and language therapy, physiotherapy, occupational therapy, school nursing and community mental health care.
- Broadly speaking, community health services have a number of key functions:
- promoting health and healthy behaviours
- supporting screening and vaccination programmes
- promoting independence
- delivering treatment in a community or home setting
- supporting care management or those with long-term conditions
- supporting rehabilitation
- providing end-of-life care.
- Primary and community care services have evolved in entirely separate ways and remain poorly integrated, despite similarities in the services they provide.
- Since 1948, community health services have variously operated under the control of local authorities, in the acute sector, as independent trusts, and most recently as provider arms of primary care trusts (PCTs). In 2005, PCTs were instructed to minimise their role in provision by contracting-out community services.
- Primary care services have similarly evolved and diversified. Over the years, the professional status of general practice has grown; more work is undertaken in health centres; and remuneration has changed to a mixture of capitation-based fees and pay-for-performance targets. Health budgets have been devolved to general practices through practice-based commissioning, moving decision-making closer to patients. There is now greater regulation of quality standards and a focus on rewarding high-quality patient care and experiences.
- The most recent articulation of the current policy vision is in the NHS Next Stage Review: Our vision for primary and community care. The policy commits to providing modern, responsive services of a consistently high standard that give patients ‘choice’, ‘personalisation’ and ‘improved access’ to a more integrated range of services, in particular services that promote healthy living and co-ordinate care for those with long-term chronic illnesses.
