ABSTRACT
For all nurses, health visitors and midwives working in primary health care since the early 1990s, change has been an ever-present part of their lives. In a book (entitled tellingly: Contemporary Primary Care. The Challenges of Change [Tovey, 2000]) Heywood (2000:26) goes further, in stating that: ‘General practice has seen a century of change in service delivery’. As part of the NHS Plan (Department of Health, 2000a), the move to make primary care the central organization in the process of commissioning and providing services has gathered pace, and primary care will soon be responsible for management of 75 per cent of the NHS budget (Department of Health, 2001a). The very purpose of the NHS Plan (Department of Health, 2000a:2) is to bring about change in all aspects of the NHS: ‘The NHS Plan sets out the steps we now need to take to transform the health service so that it is redesigned around the needs of patients. It means tackling the toughest issues that have been ducked for too long’ (our emphasis). And managers and clinicians are charged with bringing about this radical change: ‘For every example of good practice there are too many examples where change has yet to take place. Best practice can no longer be an option. Managers and clinicians across the NHS must make change happen’ (Department of Health, 2000a:9.2).
