PubMed · 1486309
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D Browning. 1992-12-05. Getting ready for change.. https://doi.org/10.1136/bmj.305.6866.1415
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The Tomlinson report, with its emphasis on primary and community care, offers great scope to community health services, for long the poor relation of the NHS, and particularly poorly resourced in London. The aim is to create services that break down the barriers between primary, secondary, and tertiary health care and concentrate on providing high quality care tailored to individual patients' needs. Thus a range of flexible options needs to be developed between acute hospital based care and the standard home care arrangements currently provided by district nurses. Examples, include hospital at home schemes, nursing beds, and rehabilitation beds. Together community and primary care services need to consider weekend coverage, to conduct research, and to become a setting for education. The infrastructure for primary and community care must, however, be put in place before acute facilities are shut.
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The article describes what can be done to improve quality in the Norwegian primary health services, seen from the point of view of the municipal health officer. Quality assurance is particularly important in the primary health services for the following reasons: They, i.e. the primary health services constitute a major part of the total health services, and they are unique by being a basic front-line service consisting of many small units. Compared with the rest of the health services, many of the personnel employed at these units are not fully qualified. As a consequence, we argue that setting quality standards and ensuring and improving quality in patient care must be an integrated part of the work of all primary health care personnel. Ensuring quality has been a major issue for the national health authorities in recent years, but has not yet been incorporated as a routine in the services. We give six examples where quality assurance is relevant, with references from research.