Published: 20/05/2004, Volume II4, No. 5906 Page 6

The NHS is seeing sustained improvement but the shift in provision of services away from hospitals into primary care has some way to go, according to a report published on Tuesday by the NHS Modernisation Board.

At a breakfast meeting with prime minister Tony Blair, the board presented its annual report, Caring in Many Ways, which concluded: 'Improvements witnessed in hospitals and in traditional primary care settings are transforming the NHS, but that is not enough.'

Bradford South and West primary care trust chief executive Dr Barbara Hakin told Mr Blair that the payment by results system was doing more to incentivise secondary care than primary care.

And she warned Mr Blair that the structural systems in the NHS needed to be monitored to make sure that primary care was also given reasons to improve.

Emergency care czar Professor Sir George Alberti said that he was 'not sure whether we have got the incentives quite right; we have got to get the system adjusted a little bit'.

Sir George told Mr Blair that the NHS still needed to look more closely at chronic-disease management in elderly care where he said it could 'do an awful lot more'.

Mr Blair asked whether patients were getting access to the right information: 'The problem with any service is that you get people who are innovators and ground breakers...then you have people who deliver a service which is below average...what can the patient do to exercise power over that situation?'

Dr Hakin told Mr Blair that patients often did not know how to access the right information.