But government cash must not be used to disguise other problems

Published: 22/08/2002, Volume II2, No. 5819 Page 17

The government is to plough£129m into day surgery, diagnostic and treatment centres and expanded primary care facilities. Good. More please. Patients will not only be treated quicker, their experience of that treatment will also be enhanced - vital in restoring confidence in the NHS. Staff will be able to work in a more efficient way and, thanks partly to happier patients, gain greater job satisfaction. In time, pressure can be eased on hard-pressed existing and sometimes failing secondary care facilities - creating the opportunity to make any necessary changes.

But the development of day surgery, DTCs and primary care centres poses a considerable challenge for clinicians and managers. Effectively it is creating what policy makers are calling a 'primary care-and-a-half ' sector in which traditional ways of commissioning and carrying out treatment will have to be re-engineered. Those in the secondary and primary care sectors must find new ways of working together.

The danger is that these new facilities will be used to disguise problems elsewhere in the system or that vested interests will see old, inefficient practices being automatically transferred. Managers must resist both the temptation to do this themselves or to remain silent when others attempt to do so.