dental business innovation

We have heard plenty recently about reforming the NHS. We seem to be, despite the proposed revolution in healthcare, stuck in a pre-determined path. Let me explain. Many years ago, with the assistance of the World Health Organisation (Declaration of Alma-Ata 1978), primary care was prioritised (quite rightly). Fast forward to recent times and we have had calls for the re-integration of health services. These have largely fallen on deaf ears, as far as politicians are concerned. In my opinion this is because the recent and current model is based on trading between primary and secondary care. The proposed reforms will, of course, take this to an unprecedented level. Basically, integration of primary and secondary care is at the opposite pole from GP commissioning. Might it not be high time to take advantage of the reforms not to completely abolish PCTs and SHAs, but to move, and merge them into the existing hospital network? Just think! We could have over-arching (both primary and secondary care) health policies and strategies, the local authorities could still be involved, and all at massively reduced cost. Why do we plan secondary care separately from primary care and vice versa? To do this would clearly mean ditching the current proposals, but I don't see the problem there as they seem to have very little support. A greater barrier would be the challenge to the idea that there should be a "market" between primary and secondary care. I believe that this is open to challenge and scrutiny and I am not convinced that the "market" approach would survive such a process.

As for dentistry, we are well aware of the discontinuities between primary and secondary care, recently made worse in many areas by alterations to referral mechanisms. In some treatment domains there is simply no secondary care available in many areas (eg endodontics), accepting that there is sometimes secondary care available in primary care settings (this is where the language and definitions get really messy depending on whether primary care is to be defined by the location, type of work done, or indeed the position in the referral chain!). It is high time that we refer to "care" as a default and retain "primary care" and "secondary care" as subordinate terms.

I believe that we should look at ending two systems run in parallel (primary and secondary care)and start to integrate them.