DETERMINING PRIORITIES FOR CHANGE IN PRIMARY-CARE - THE VALUE OF PRACTICE-BASED NEEDS ASSESSMENT

Background, Primary care is being expected to expand the range of serv ices it provides, and to take on many of the tasks traditionally provi ded in secondary care. At the same time, general practitioners (GPs) w ill become increasingly responsible for assessing their patients' heal th care needs and commissioning care from other providers. This articl e describes an approach taken in one general practice to meet these di fficult challenges. Aim. To examine whether information on health and health care needs, when used as the basis for a priority setting exerc ise, can provide a useful first step in planning primary care provisio n within a practice. Method. A three-stage process of information-gath ering from a number of sources, including continuous data recording of patient contacts and a postal survey of all adults registered with th e practice, identification of key findings and discussion of associate d issues, and priority setting of proposals for practice development u sing the nominal group technique. Results. Continuous data recording o f patient contacts with GPs and the practice nurse provided data on 44 89 GP contacts with 2027 patients, 1000 district nurse contacts with 1 01 patients, and 361 health visitor contacts with 172 clients. More th an 70% of patient records had been computerized, with 600 diagnostic R EAD codes identified and 11 500 separate entries made. The socioeconom ic and health survey questionnaire achieved an 84% response rate. Foll owing the priority-setting exercise, 28 proposed practice developments were identified. These were reduced to a final list of eight. Conclus ion. A comprehensive method of practice-based needs assessment, when u sed as the basis for some form of priority setting, has great potentia l in helping to plan primary care services within a practice. The succ ess of such initiatives will require a substantial investment of resou rces in primary care and fundamental changes to the way in which prima ry care is funded.