Review

New ideas in practices

TRANSFORMING PRIMARY CARE: personal medical services in the new NHS
Richard Lewis & Stephen Gillam (eds)
Kings Fund, 1999, £12.99

The first personal medical service (PMS) pilots were set up in April 1998 and are intended to provide opportunities for innovation. They allow greater flexibility in organising and financing primary care, including allowing GPs to be employed rather than being independent contractors. They also allow primary care services to be led by trusts or nurses, as well as GPs.

The book draws on material from nine of the first pilots which are part of a development project to share early learning, and covers the six-month preparation period and first year of operation. It is refreshing to be able to access findings so quickly.

Some chapters do point to new forms of practice. For example, ten of the first wave PMS projects were nurse-led. There is an example of primary assessment and management of patients being undertaken by a nurse and another of patients having a choice to see a GP or nurse. The chapter on primary care organisations, where the aim is to provide integrated primary care, is also very interesting. In Tipton Care Organisation a real attempt is being made to break down divisions between health and social care involving social services and voluntary organisations and to involve patients as active partners. While the book paints a very positive picture in general, Rod Sheaff’s study found few changes in contracting and obstacles to progress are identified in several chapters.

The main weakness is a lack of critical analysis. Terms like ‘cost-effective’ are used without any discussion of what they mean, so at times it is difficult to fully understand the issues under discussion and feels like reading a progress report. The chapter called reducing inequality is about access to health services and while this is an important area where PMS pilots may be able to make a significant contribution, they won’t on their own reduce inequality in health status, yet this distinction is never made.

This is a short, informative book that is easy to read, and I would recommend it to anyone who wants to know more about what a PMS pilot is and what it may be doing.