Headlines: March 13th, 2003

From next month Primary Care Trusts will become responsible for three quarters of the NHS budget amounting to 46 billion pounds as they take on the responsibility for commissioning treatment for local patients. The shift in the health service balance away from acute hospital services is partly because medical advance is moving towards primary care and also because the increasingly ageing population will have conditions better treated in primary care. In addition, as patients are given more choice about treatment facilities, they will need to rely more on doctors and nurses in primary care for advice. Health Secretary Alan Milburn said: “The Government wants to see prevention and treatment expanded in primary care.”As medical science converts life threatening diseases into chronic conditions the need to treat the frail and elderly near to home increases. The latest census showed that 18% of the population, nearly 9m people, have a limiting long-term illness such as arthritis. The number of people in the UK over 60 will grow by one third up to 2021. The challenge of chronic disease is set to grow over the years to come. This calls for greater emphasis on expanding primary care services so they can work more effectively in partnership with patients.

Medical advance and technological change are also on the side of primary care. Future technological change – near patient testing, digital imaging, telemedicine – together with new treatments and prevention strategies will all support an expanding role for primary care in taking a lead in the management of chronic disease.

For the future Alan Milburn is exploring how the concept of earned autonomy can be applied to Primary Care Trusts so that those who are performing best get more freedoms and those that need more help get greater support. He is also looking at how Practices should benefit from earned autonomy as relationships with Trusts develop.