Keith Palmer argues persuasively that there is a need to maintain the momentum of reform (Opinion, page 22, 12 October) but his analysis illustrates a fundamental difficulty. He focuses largely on secondary care and the only reference to general practices is about their referrals to other services, although he does discuss practice-based commissioning elsewhere.
With a background in general practice, and for the last four years a PCT chair, I continue to be surprised by the lack of clarity and consistency in thinking about the sector. While the recent focus on care outside hospital and PBC does represent a shift in thinking, there seems little recognition of the benefits to be gained from enabling practices to develop their roles as comprehensive providers of primary care.
Continued reform of the secondary care sector and reconfigurations that are insensitive to practice development are putting the cart before the horse. The recent consultation launched by Lord Warner - direction of travel for urgent care - may presage further fragmentation and reduce the potential for the improvements in service and economies that are required.