Primary care development zones.

Abstract

The remedial programme should aim to make up the deficit in primary and community health services in the capital, to bring them into line with national standards. Investment in the 46% of general practitioners' premises which the Tomlinson report identified as substandard will be needed. So will improvements in the quality and quantity of conventional primary and community health services currently available to Londoners. NON-STANDARD SERVICESA service development programme is needed to provide non-standard services to groups for whom the traditional model of primary care, based on serving a family of fixed abode, is inappropriate. These groups of Londoners are very diverse. They consist of highly mobile young people and families, commuters, and tourists, as well as disadvantaged groups such as refugees. They also include some people from ethnic minorities, homeless and rootless people, homeless families, and substance misusers.The small scale of primary and community health services give them the potential for meeting such diverse needs flexibly, in ways that institutions cannot. There are a wide variety of project based experiments to draw on when devising a pattem of services geared to the needs of marginalised groups: they include "sick bay" services for homeless and rootless people; services provided by salaried general practitioners or community nurses for families in bed and breakfast accommodation; interpretation and advocacy for people from ethnic minorities; and outreach teams for substance misusers and street and hostel dwellers with mental health problems.The

Evaluation of specialists' outreach clinics in general practice in England: process and acceptability to patients, specialists, and general practitioners.

“…Twenty seven per cent (37) of outreach patients and 29% (36) of outpatients said they had no pain in the past four weeks. Nine per cent of outreach patients (12) and 9% (11) of outpatients said that over the past four weeks they had felt "full of life" none of the time. These results confirm all but one of the specialists' reports of no differences in casemix in relation to site (see earlier).…”