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The big wheel keeps on turning
  1. Bess Driver
  1. The Old Depot Surgery, Cuminphrees, UK

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The wheels on the bus go round and round, round and round, round and round, all day long. Those of you who have children know this song. It's great. At least, it is for the first 10 times of listening. In the same way, some have welcomed reorganisations of the National Health Service (NHS) as the way forward – but again, and again, and again, year in, year out?

My first experience of primary care management was the Family Health Services Authority. If my memory serves me correctly, next came the Health Commissioning Agency – in fact, there may have even been something in between these two masters, but a lack of enthusiasm for this subject, a fear of reawakening past memories, and a patient requiring emergency contraception in the waiting room, give me three good reasons not to Google™ the subject. Anyway, before long – about 18 months, I think, as this seems to be the time the NHS can last before it craves its next fix of new letterheads – along came primary care groups, closely followed by primary care trusts (PCTs), who soon rebranded to become ‘NHS XYZ’ in order to take advantage of the protection afforded them by being part of the NHS family. In essence all these organisations were the same – they did the same job, and were made up of the same people.

But, now – it's the end of the line for PCTs, isn't it? Primary care has grown up and no longer needs ‘parents’ to look after it. Primary care is now considered mature enough to have its own bank account, to manage its own finances, but like children at this same stage in life, primary care is off to college, because let's face it, the White Paper means it has a lot to learn.

The students of today face an uncertain future: the prospect of unemployment and huge debts being the dim light at the end of their tunnel. If we're not careful primary care will find itself in exactly the same position. But wait a minute. What is it that parents always say? You never stop being a parent, whether it's doing the bags of washing brought home from college or being a listening ear on the phone. Primary care has enough to cope with, and is being stretched to breaking point. It will need help, that's for sure. After all, being a student, learning new skills, means making mistakes. Primary care will have to learn ‘on the job’, like couples trying out new contraception, some finding themselves pregnant because it hasn't worked quite as they thought it would, or something was forgotten altogether.

So who is going to fulfil this parental role in the future? One sort of parent is likely to take health care back to pre-1948 times; the other parent will keep things ticking over as they are, albeit doing this under a different name. Either way you'll see that the wheels of the health care bus continue to go round and round, round and round, round and round – all day long.


  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.