Key Professional Issues

Abstract

A wind of change is sweeping through the health service and its repercussions are being felt at the grass-roots level in primary care. Inevitably this is affecting patient care. Doctors’ and counsellors’ expectations, their roles and their relationships are being redefined. Patients are now expected to be more responsible for their own health. Exercise, diet and a healthy lifestyle are a few examples of this. Old assumptions about universal care ‘from cradle to grave’ are changing, and now that the dependency culture of the postwar decades is being swept aside, governments are urging us to invest in pensions to see us through our old age. The same applies to primary care and the rise of fund-holding practices. Doctors have had to reassess their allocation of funds. Who gets what and how much has been delegated to the local level, which means that decision making in health care is community- and patient-responsive. Choice has been the political justification for many of the changes, but few believe that there has been an equitable distribution of resources geographically and generationally, and even across gender and illness lines. While fund-holding practices have broken new ground by providing on-site counselling services for their patients, this may be financially motivated: counselling is cheaper than psychiatry.