'Social capital consists of.connections between family, friends, neighbours, the people we work with, and membership of community and civic organisations.'

Individual choice and personalisation of services is a theme of the recent NHS reforms. Another trend is a focus on new forms of collective organisation, such as social enterprise bodies to expand choice for patients. The potential role of such organisations is enhanced by an understanding of civil society or social capital.

So, how is your social capital? It's a rhetorical question, as social capital is not about individuals. It is about the interconnections between people. Robert Putnam, in his book Making Democracy Work, defined social capital as 'the features of social organisation such as trust, norms and networks that can improve the efficiency of society by facilitating co-ordinated actions'.

He described the components as common interests, civic engagement, local identity and reciprocity. At the heart of the concept is the creation of trust through networks that provide personal and social support by the sharing of knowledge, skills and material goods.

In our own lives social capital will mean connections between family, friends, neighbours, the people we work with, and membership of community and civic organisations.

Bonding and bridging

Much has been written about social capital; challenging the concept or adapting it. For example, it is proposed that there are different types of social capital: bonding and bridging.

Bonding social capital might exist in a neighbourhood or professional group and can apply to the workplace, such as a primary care team or hospital, where you find like-minded people with shared norms and networks.

Bridging social capital refers to the links between different social groups, organisations and the communities they serve. It provides a framework for the creation of successful relationships with communities, and the potential to develop a flexible and patient-centred health service.

Both primary care and foundation trusts are required to have local connections. Voluntary and social enterprise organisations are often strongly embedded in local communities. Although the health professions and the NHS start from a high level of public trust, how might they maintain and build on that?

At the core of maintaining this relationship is the struggle to ensure that an individual's personal experience of NHS care is high quality, which in turn creates a trusting relationship.

Moving from the individual to the collective level brings public expectations that services will be used according to need, supporting the creation of trust by building on the principle of fairness. There is an expectation that the NHS will provide bridging social capital by encouraging exchange between patients and other agencies; signposting and making connections to other services and different social networks.

These actions require a wide range of skills and organisational models. It is essential that clinical and managerial time is spent delivering care and that time spent developing internal and external networks is valued.

Better quality and more efficient solutions can emerge through these networks, which lends support to the adage that it's who you know, not what you know.

Dr Ruth Hussey is NHS North West regional director for public health