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Conservatives throw spotlight on primary care

The catalyst is the merger next year of family health services authorities in England with local health authorities. Mr Dorrell views this as an opportunity to deliver fully integrated primary care. To an audience of the Conservative Medical Society, Mr Dorrell characterised it by saying that he wanted to bring health care out of the ivory tower and make it more easily accessible to patients. He said, "Those in primary care can act as advocates for the patient to the rest of the health service. The NHS may seem rational to those working in it, but for those outside it is very difficult to understand, and they find themselves getting lost."

He promised to address the question of skill mix to ensure that the skills of professional people were properly used in a structure that facilitated skill mix. "This is a period of stability in the government's relations with the professions. It is an opportunity for the government and the primary care profession to move beyond the kind of arguments we have seen going on for the past five years and to sit down together to look at the development of primary care," Mr Dorrell said.

In a second announcement the health secretary turned to accident and emergency departments, saying that excessive waits on trolleys were not acceptable. A new charter target will stipulate that patients should spend a maximum of two hours in an accident and emergency department before admission. In next year's round of contracts health authorities will be expected to have a clear view of how providers should improve disciplines within the accident and emergency service.

Mr Dorrell's main political message to the conference was of a 5% reduction in NHS management costs to divert pounds sterling140m from bureaucracy to patient care. He is to appoint a scrutiny team that will report in 90 days how NHS administration can be streamlined. He said that although it had been right to build up management, this had led to some unnecessary processes and needed to be tightened up.--JOHN WARDEN, parliamentary correspondent, BMJ

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