When the National Health Service came into being in 1948, primary care services comprised general medical services, general dental services, supplementary ophthalmic services and pharmaceutical services. For the most part, these services were provided by independent practitioners, a situation that generally prevails to this day. But patterns are beginning to change. New types of service are being brought in. We are beginning to see, for instance, nurse-led walk-in centres in various parts of the country. As an article in this week's issue makes clear (see p305), they are designed to broaden access to primary care. Some people, such as those not registered with a general medical practitioner, have no easy access to primary care services and even those who are registered do not always find it easy or convenient to get an appointment with a doctor. They can now, in many parts of the country, seek treatment or advice at the new centres.
The centres seem to us to be something of an experiment. The Government seems to be setting them up in the hope that they will work. They will be evaluated and presumably modified as experience with them grows.
The same might be said of NHS Direct, another nurse-led service, which offers advice to telephone callers about what to do about health problems. The nurses take callers through a series of questions prompted by algorithms and end up giving them advice about what they should do.
The service has, of course, been the subject of an independent evaluation carried out covertly by the Consumers Association using its well known fictitious patient technique. And, as readers may recall, NHS Direct has been found wanting (PJ, August 12, p220). According to the CA research, it failed to spot some potential emergencies.
Pharmacists may have some sympathy with NHS Direct, because the same technique has been used to test their advisory capabilities. And ironically, the same defence that has been used on behalf of pharmacists was used by supporters of NHS Direct, namely, that the work of the service was being compared with a gold standard set by armchair critics rather than with what was on offer elsewhere through not always perfect general medical services.
Since the Government is clearly in experimental mood, we suggest that there is one other experiment that it might well want to try. That is to let pharmacies perform an equivalent role to the walk-in centres. They already do so informally, as the President of the Society has pointed out, so why should they not be allowed to do so officially as part of the NHS.
In case it should be argued that there is no evidence that such a service would work, we would simply re-emphasise that walk-in centres and NHS Direct amount to experimental services. What is sauce for the goose could open the way for a new source of NHS services.