Applying community-oriented primary care methods in British general practice: a case study.
BACKGROUND
The '75 and over' assessments built into the 1990 contract for general practice have failed to enthuse primary care teams or make a significant impact on the health of older people. Alternative methods for improving the health of older people living at home are being sought.


OBJECTIVE
To test the feasibility of applying community-oriented primary care methodology to a relatively deprived sub-population of older people in a relatively deprived area.


METHODS
A combination of developmental and triangulation approaches to data analysis.


METHODS
Four general practices in an inner London borough.


METHODS
A community-oriented primary care approach was used to initiate innovative care for older people, supported financially by the health authority and practically by primary care academics.


RESULTS
All four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation processes in only one practice. Innovations were sustained in only one practice, but some were adopted by a primary care group and others extended to a wider group of practices by the health authority.


CONCLUSIONS
A modified community-oriented primary care approach can be used in British general practice, and changes can be promoted that are perceived as valuable by planning bodies. However, this methodology may have more impact at primary care trust level than at practice level.
Iliffe
Steve
S
Department of Primary Care and Population Sciences, Royal Free and UCL Medical School, London. s.iliffe@pcps.ucl.ac.uk
Lenihan
Penny
P
Wallace
Paul
P
Drennan
Vari
V
Blanchard
Martin
M
Harris
Andrew
A
D000368:Aged; D018672:Community Health Planning; D003153:Community Health Services / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011320:Primary Health Care / Q000379:methods*; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom