Archive

Edited by Bernard Dowling and Caroline Glendinning.
Open University Press 
ISBN 0335212506
£19.99

Shifting the balance from secondary care in hospitals to primary care in the community is at the heart of the government's modernisation programme. Primary care trusts are the delivery vehicle for this care. But are they working?

This book examines different facets of primary care: the changing doctor-patient relationship, the poor quality of information about practice, the partnerships seen as the key to tackling health inequalities and the chances for patient and public involvement.

It is always difficult to examine a health care system in transition but many valuable insights are provided into the tensions in the NHS. The language of a clinically led service and devolution to the front line is difficult to reconcile with the centralised managerial culture of the NHS where targets are everything.

Although the authors say the jury is still out on the success of the reform programme, they note that the organisational upheavals which have characterised the NHS have damaged the building of stable external relationships and partnerships on whose success so much hangs.

The final sentence of this useful book warns against the dangers of over-ambition and impatience as potentially destabilising the system.

Terry Bamford is chairperson, Kensington and Chelsea Primary Care Trust.