Towards managed primary care: the role and experience of primary care organisations
International Journal of Integrated Care, 31 January 2007 - ISSN 1568-4156
Book review
Towards managed primary care: the role and experience of primary care organisations
Judith Smith and Nick Goodwin
Aldershot: Ashgate Publishing Limited, 2006, pp 243,
ISBN 0 7546 4227 5
H.J.M. Vrijhoef, Ass. Professor at the University of Maastricht

Today's choices influence the future. Smith and Goodwin have written an evidence-based book, entitled ‘Towards Managed Primary Care’, on the transformation in the organisation and the management of primary care. In line with the work by Edward Wagner and the World Health Organisation, this book embraces a new way of managing the most prevalent health problems: integrated care for patients with chronic diseases. For this, organised systems of care, not just individual health care workers, are essential in producing positive outcomes.

The main focus of the book is on the practical experience of developing and managing primary care. Based on this, lessons are drawn for future policy relating to the management and evaluation of organisations in primary care in the UK and elsewhere. Moreover, almost each of the 14 chapters of this book contains valuable lessons for practice and research (Chapter 2 until 13), while lessons for policy are drawn in the two final chapters. Realizing the professional background of the authors the lessons for research were expected. This is the surplus value of this work above the existing literature.

The first section of the book (Chapters 2, 3 and 4) deals with exploring the context and conditions within which primary care organisations have developed in the UK, the USA, the Netherlands, Sweden, New Zealand and Australia. Chapter 4 clearly describes the underlying difficulties of, or challenges for, evaluating the highly complex policy initiatives such as primary care trusts or groups.

The second section of the book (Chapters 5, 6, 7 and 8) is about the organisation and management of primary care groups and trusts. These two forms are being regarded as the most ambitious incarnations of primary care organisations in the NHS. Chapter 5 examines the organisational and governance arrangements put in place by primary care groups and trusts over the period 1999–2004. The overview is impressive and very helpful in better understanding changes towards new arrangements. This is also the case for Chapters 6 and 7. These chapters deal with how to engage local professionals and other staff, i.e. general practitioners, nurses and allied health professionals, in the strategic and operational development of primary care organisations. From the overview given, the recent expansion of the role of nurses into independent describing is no surprise. In Chapter 8 an overview is given of the experience of performance management in primary care organisations at the individual, practice and organisational level. For policymakers the extensive list of lessons on this topic is very interesting.

The final section of the book (Chapters 9, 10, 11 and 12) focuses on how primary care organisations can become vehicles for change. Chapter 9 explores the problematic public health role of primary care organisations and considers to what degree there has been success in achieving health improvement objectives. Chapter 10 examines how primary care organisations have developed and improved primary care services. Both for researchers and policymakers the list of lessons on this topic is tremendous. In Chapter 11 an assessment is made of the experience of primary care organisations in (their potential to) developing the commissioning function and bringing changes to clinical services in intermediate and secondary care. Chapter 12 concentrates on the issues faced by primary care organisations in attracting clinicians to work within a more managed system. It also considers the extent to which general practitioners, nurses and allied health professionals feel engaged with these primary care organisations.

Chapters 4 and 13 will be very welcomed especially by researchers and students when preparing their proposals for scientific evaluations of primary care organisations. In Chapter 13 conclusions are drawn with regard to what is known in terms of the implementation, development and impact of primary care organisations in order to develop an agenda on how primary care organisations in the future should be evaluated.

Based on the work in the former chapters, Smith and Goodwin are looking to the future in the two final concluding chapters. The book's overriding conclusion is that primary care has become increasingly more important within many health care systems, and as part of this, the governments of many countries have sought to manage primary care more closely and effectively. When following the key lessons from this book primary care will be more strongly managed and as a consequence better equipped to face current and expected health care problems. Furthermore, as Smith and Goodwin mention, one of the next challenges is to position the primary care organisations within a chronic disease model. By this chronic diseases will be managed in the most appropriate and cost-effective care settings.

In conclusion, this book provides valuable lessons for professionals, managers, policy makers and students with an interest in health policy. If you are one of them, this book leaves you no choice: just read it!