Review

Moving in circles

A PUBLIC HEALTH MODEL OF PRIMARY CARE: from concept to reality
Taylor P, Peckham S, Turton P
Public Health Alliance, 1998

This is a brave book because identifying a public health model for primary care in the UK in the 1990s is problematic. The model it proposes is very simple: three interconnecting circles, entitled equity, participation and collaboration. The book consists of literature reviews on each topic and four case studies. There is also a thorough analysis of the current relationship between public health and primary care.

The book makes depressing reading. It illustrates that despite many attempts by many people over many years, a public health model of primary care remains marginal to the medical model. At times it can be dense and abstract but the case studies provide welcome examples of practice.

The key issue is well explained: a major barrier to implementing a public health model of primary care is the incompatibility between the 1991 NHS reforms and the public health reforms introduced by New Labour.

Particularly useful sections are about identifying appropriate methods of evaluation, and the current structure of health services. The book shows how organisational development literature can be used to identify flatter structures and emphasises the need for health improvement plans to be based on local community action rather Primary Care Groups.

The evidence from the case studies could have been used to illustrate how hard it is to support and develop effective participation, and to set the discussion in terms of our increasingly fragmented society.

The case studies suggest, not surprisingly, that it is easier to develop participation in a small, affluent and cohesive community. The book takes Sheffield as an example, and illustrates the difficulties a city-wide public health strategy can cause at neighbourhood level. Greater exploration of these issues would have been welcome.

If you are interested in how public health and primary care can work together, this book is a good starting point. It draws together information on where we are now — and makes some good suggestions about where we go from here.