ABSTRACT
Strategy is defined in dictionaries in military terms – 'a plan for doing something important, especially in war' – and successful military campaigns revolve around a limited number of specific objectives. Providers, in primary care or secondary care, are usually reactive to the needs and wants of the individual. In local commissioning, primary health care, secondary health care and health authorities will need to assess the needs of their local population, understand the evidence which supports or reflects the proposed treatment or services and then deliver efficiently services to people who can benefit. The publication of the first Health of the Nation documents hardly made a huge impact on either the public or mainstream clinicians. The audit-education cycle as advocated by J B McWhinney, produces a process that begins with reflection on practice rather than a set of received standards. The fusion of evidence of effectiveness, needs assessment, reflection on current practice and audit moves towards new paradigm research or collaborative enquiry.
