NHS Direct: managing demand

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Abstract
The second 50 years of the NHS will see a very different relation between the service and the public it serves. One of the four key themes of the white paper is the introduction of NHS Direct, a 24 hour nurse led helpline. After piloting it will cover the whole country by 2000, as proposed in the chief medical officer's report on emergency services in the community.1 However, NHS Direct is not solely about telephone advice lines. It should also herald a fundamental shift in the NHS where more public participation in health care can happen closer to home and where more care can be delivered without face to face contact. It may well be the most important development this white paper has to offer. NHS Direct has profound implications for the shape and purpose of the developing health service in general and primary health care in particular (especially if the gateway to the NHS moves from the surgery to the sitting room). A publicly led NHS may soon complement a primary care led …

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