From MARTIN McKEE
In seeking to justify the high level of hospital provision in inner
London, Edwin Gale (Letters, 19/26 December) claims that ‘the notion that
improved primary care will reduce the need for secondary care is demonstrably
incorrect’ and that ‘good primary care increases specialist referral rather
than reducing it’.
Unfortunately these statements are not supported by the evidence. In
the US, studies have demonstrated how patients are admitted to hospital
for conditions that should have been managed in the primary care setting.
The admission rate for these conditions from individual areas is strongly
associated with lack of access to primary care. In Britain, there is increasing
evidence that many chronic conditions, such as diabetes and asthma, are
better managed in the primary care setting, and that high-quality primary
care can reduce the rate of admission to hospital for exacerbations or complications.
The population of London has, for many years, been faced with the paradox
of proximity to ‘centres of excellence’ that treat rare diseases, but lack
of access to basic services, including primary care and basic secondary
care. At last, the Tomlinson Report provides an opportunity to redress the
balance. Gale may be right to be cautious about the extent to which primary
care will be adequately improved, but, if real improvements are brought
about, the demands on in-patient secondary care are likely to fall, not
rise.
Martin McKee London School of Hygiene and Tropical Medicine University
of London
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