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Abstract

This article explores the systemic roots of the concept of community care as developed by Geoffrey Vickers in the 1960s and its subsequent elaboration in theory and in practice. It analyzes the radical 1990 reforms in the U.K. National Health Service in terms of an attempted shift to automatic market regulators to carry the gross burdens of choice that colliding expectations and relatively fixed resources are generating in health care, and it explores the changing role and possible changing training of practitioners in health and social care delivery.

I am afraid of those who look for a tendency between the lines and who insist on seeing me as necessarily either a liberal or a conservative. I am not a liberal, not a conservative, not a gradualist, not a monk and not an indifferentist.

—Anton Chekov

Letter to Alexey N. Pleshcheyev

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Community Medicine and the World of the Well

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