Hospitals and primary care : breaking the boundaries

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This working paper is based on the assumption that change in the direction of primary health care is desirable and inevitable. It explores the interface between acute hospitals and primary care, and describes developments that improve integration and show how a shift towards primary care might be achieved. It goes on to examine the prospects for similar developments being introduced on a wider scale in London. Chapter 2 in this working paper gives a brief description of what is meant by primary care and provides summary of recent policy developments which put primary care in context. Chapter 3 concentrates on the interface between primary and secondary care and looks at how the interface might be managed more effectively so that it does not become a barrier to care. The issue of inappropriate use is also explored. In chapter 4 developments that span the traditional inappropriate use of services are described. These give an indication how primary and secondary care may change in the future. Chapter 5 explores whether similar developments could happen on a wider scale in London. The shift away from hospitals and towards primary care is discussed in the context of London's unique social and demographic characteristics, its infrastructure of primary and community services, the capacity for managing and planning services, and the impact of the NHS reforms.

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