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Most analysts agree that one of the keys to the future of the NHS is a re-balancing of activity between primary care (general practice and community services) and secondary (hospital) care, combined with better, more coordinated working between these and other health and social care sectors. These proposals have major implications for the use of resources and of the NHS estate, and for professional careers and identities and raise a host of new questions.How important is the location of services and will we have to close and sell off hospitals to really shift resources into primary care? How can tensions between generalist and specialists be resolved and real integration and joint working be achieved? Will the IT systems ever catch up with changing structures? How can we develop an evidence base for the effectiveness of the reforms, and how can we share best practice? Is it really possible to design services around patients, and how can the ‘patient voice’ truly be heard and heeded in service development? And finally, which, if any, of the proposals for change are going to save money? This last question is critical, not only because of the financial constraints now being placed on the NHS, but also because of recent evidence that seems to show that, while countries with strong primary care have better health outcomes and less health inequality, overall costs of health care may be higher.1We asked four people, who are particularly well placed to comment on the future of the service, to give us their perspectives on how things may develop in tomorrow’s NHS.1. 1.↵1. Kringos DS, 2. Boerma W, 3. van der Zee J, 4. Groenewegen P (2013) Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood) 32(4):686–694, doi:10.1377/hlthaff.2012.1242. [OpenUrl][1][Abstract/FREE Full Text][2]# Shifting Care from Hospitals to ‘Community’: A Role for Hospitals? {#article-title-3}Mark NewboldThere is broad consensus that care must shift from hospital to community in the coming years, but is there is a common understanding of what this means?It is a shift in the … E-mail: james.reilly{at}clch.nhs.ukE-mail: renata.drinkwater{at}selfmanagementuk.orgE-mail: bexleycc{at}nhs.net [1]: {openurl}?query=rft.jtitle%253DHealth%2BAffairs%26rft.stitle%253DHealth%2BAff%2B%2528Millwood%2529%26rft.issn%253D0092-8577%26rft.aulast%253DKringos%26rft.auinit1%253DD.%2BS.%26rft.volume%253D32%26rft.issue%253D4%26rft.spage%253D686%26rft.epage%253D694%26rft.atitle%253DEurope%2527s%2BStrong%2BPrimary%2BCare%2BSystems%2BAre%2BLinked%2BTo%2BBetter%2BPopulation%2BHealth%2BBut%2BAlso%2BTo%2BHigher%2BHealth%2BSpending%26rft_id%253Dinfo%253Adoi%252F10.1377%252Fhlthaff.2012.1242%26rft_id%253Dinfo%253Apmid%252F23569048%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=healthaff&resid=32/4/686&atom=%2Fbjgp%2F63%2F612%2F379.atom

british journal of general practice

The future of primary and secondary careShifting Care from Hospitals to ‘Community’: A Role for Hospitals?Three Key Features in Community Healthcare ChangesGiving Patients a Better Healthcare ExperienceTaking Care