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Don't forget patient in the care debate; THE PROFESSIONALS.

Byline: Mike Ponton

WHEN it comes to the public debate about the NHS, the primary care sector is often overshadowed by its headline-grabbing partner, the acute hospital sector, which takes more than half of the NHS budget and most of the media spotlight.

Primary care is the term used for community-based health services that are usually the first, and often the only point of contact that patients make with the health service.

Primary care teams include GPs, nurses, pharmacists, optometrists, dentists and other health professionals, who work closely with colleagues in community services such as mental health, child health and midwifery.

But despite 90% of the 20 million-plus contacts between Welsh patients and the NHS taking place in primary care, it is still perceived as having a "gatekeeper" role that suggests it is at the periphery at the health service.

For this reason, we believe that the role of primary care needs to be strengthened and put at the centre of the NHS.

So how do we go about making sure that primary care can take its rightful role at the heart of a healthy NHS?

Increased capacity is needed to address a legacy of under-investment. There is a fast-growing demand for primary care services - it is currently increasing by around 5%every year, expenditure on drugs alone is increasing by around 10%.

Meeting this massive challenge will only be possible with sustained investment in additional resources and staff.

Workforce capacity needs to be increased in all parts of the primary care team. We need to promote the status of primary care and its attractiveness as a career option, but retaining staff requires investment in training and skills development.

Further investment is also needed to strengthen management expertise. The role of local health boards - and their successor organisations is crucial - as they will continue to have a vital leadership part to play.

We need to make better use of the skills of all the professions in the primary care team - primary care isn't just about GPs.

We need to encourage and support extended roles for other members of the primary care team, such as nurses, pharmacists, therapists and practice managers.

It is important to find new ways of working, with services redesigned around the patient rather than organisational boundaries. The forthcoming restructuring of the NHS must provide a platform to build more integrated services from the ground up.

For example, much outpatient activity currently carried out in hospitals could be done in primary care premises, provided that the necessary resources and support were made available.

Primary care resource centres, which bring a range of services under one roof, such as GPs, outpatient clinics, diagnostic tests and social care, would help to create a more seamless service, bridging the boundaries between primary, secondary and social care.

Primary care can also play a crucial role in forging closer co-links between the NHS, local government and the voluntary sector.

We must not forget the important role patients can play. We need to find innovative ways of engaging patients and the public and empowering them to get involved in how we design and deliver their primary care services.

Developing investment in IT is an important investment in patient care. A comprehensive and effective IT system would vastly improve continuity of care and would bind together individual teams and the health system as a whole.

The physical state of many of our primary care premises needs to be improved for primary care to strengthen its image and position in the health system as a whole.

This is not to say that we should neglect the enormous amount of work done in secondary care, or the importance of it.

No sector is an island, and strengthened primary care services should be part of a strong NHS.

The way NHS services currently operate is unsustainable. Providing more out-of-hospital services will bring care closer to where patients live and allow better use of our hospitals.

Much is already being done to improve primary care in Wales, but we have to redouble our efforts in giving it a special focus and protected investment so that it is fully prepared to assume its leading role at the heart of the NHS.

Mike Ponton is director of the Welsh NHS Confederation
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Date:Jun 16, 2008
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