HEALTH NEEDS ASSESSMENT IN PRIMARY-CARE - THE EVOLUTION OF A PRACTICAL PUBLIC-HEALTH APPROACH

The purpose of the paper is to place health needs assessment in its pr imary care context. This is a dynamic context where changes in policie s, staff roles and patient expectations have all to be considered. Giv en this complexity and the variations between practices, it is necessa ry to help primary health care teams (PHCTs) to understand their stage of development and how this will directly affect any health needs ass essment. The technical and methodological aspects of health needs asse ssment have been explored and described by others, and that work will not be duplicated here. This paper reviews the health needs assessment (HNA) work of the Ribblesdale Total Purchasing Project (RTPP) and the n sets this review against the political, organisational, professional and practical pressures that currently confront primary care. Out of this analysis emerges a diagnostic and development tool which links to gether, and emphasises the intimate relationships between, five stages of development needed for effective primary care-oriented health need s assessment work. The emphasis is on understanding the place of healt h needs assessment within the general processes and systems of the pri mary health care team. The paper concludes by suggesting ways in which public health practitioners and specialists might approach the task o f supporting and influencing the evolution of the recently proposed Pr imary Care Groups and Primary Care Trusts. The overall intention of th e article is to stimulate debate and action.