For an integrated primary care network

When we think of primary care, we tend to stick to the services provided in health centres, but too often we forget that luckily, other actors work in the territory, such as continuous and urgent care devices, community-based services, social services, mental health and addiction teams, sexual and reproductive health care services, public health teams, rehabilitation providers, palliative care teams, and others that may specifically exist in some places.

For years it has been thought that comprehensive health organizations (CHO), also called territorial managements, are the governance model that should facilitate the long-awaited integration of processes. However, progress is scarce and slow and, besides, one of the complaints about primary care is that, in CHO’s, it too often dissolves into the complex organizational charts of hospitals, occupying irrelevant positions and losing many budget battles.

Now, an initiative of the English (NHS Long-term Plan 2019), promotes the governance of the network of health and social services of each territory, through the primary care networks, organizational structures that would allow primary care to have much more force, since they would manage, under the same umbrella, all the health and social services that act in the same community, which would become more efficient, more attractive to the professionals involved and could address community health activities in a more coral way.

Historically, hospitals have had a lot of voice, thanks to which they have obtained generous budgets and achieved great milestones in clinical outcomes, especially in patients suffering from acute illnesses. Now that the paradigm has shifted towards chronicity and frailty, the voices of primary care and community work must make their way into the organization charts, through the promotion of an integrated network of primary care. This organizational model, as the English one, should allow, within the framework of CHO, that the different services that operate in the same territory have a shared project and a unified management team that helps combat fragmentation and that knows how to defend just budgets for valuable services.

Jordi Varela 
Editor