Penny Lenihan

Integrating Primary Care and Public Health: Learning from the Community-Oriented Primary Care Model

Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britains NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.

Promoting innovative primary care for older people in general practice using a community-oriented approach

The assessments of patients aged 75 years and over that were built into the 1990 contract for general practice have failed to enthuse primary care teams or to make a significant impact on the health of older people. The lack of an evidence base for these checks, and the absence of any training programme for practice staff involved in the assessment of older people, both appear to be important factors contributing to the failure of this approach. Alternative methods for improving the health of older people who are living at home are being sought. This paper describes the use of a model of community-oriented primary care (COPC) to initiate innovative care for older people in four exemplar practices in an inner-city area of London. Pump-priming funding was supplied for a 2-year period by one health authority, with the proviso that all innovation must be self-sustaining. The project was supported by an academic department of primary care, which promoted discussion about objectives and priorities, provided the evidence base for interventions considered by the practices, supported staff and created an evaluation framework, but avoided any prescriptive intervention in the process of innovation. All four practices have successfully identified different problems that need attention in their local populations of older people, and developed different projects focused on particular needs among older people. The effectiveness of the COPC method in promoting change in these practices was sufficient for the health authority to fund a second stage, extending the method to 40 practices over a 2-year period.

Counselling the community: the contribution of counselling psychologists to the development of primary care

The primary care groups (PCGs) newly introduced to the National Health Service require general practitioners and primary care teams to improve the health of their communities by addressing the health needs of their population, promoting the health of that population and working with other organizations to deliver effective and appropriate care. Community-oriented primary care (COPC) is an internationally tested model for primary health care development which is now being employed within the UK. This paper outlines the COPC model, and demonstrates how the skills and knowledge base of counselling psychologists and primary care counselling can contribute to a community-oriented primary care approach.