Community involvement and Primary Care Trusts: The case for social entrepreneurship

Abstract

This article looks at the different and sometimes conflicting policy drivers for a move towards greater community involvement in primary health care. In this context, research findings focusing on community involvement initiatives that have taken place within general practices, Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) are explored and the key issues for implementation are appraised. Using an evaluation of a team set up to foster community involvement with the PCTs in Bradford, the utility of a social entrepreneurship approach is considered. It is argued that this form of approach can be employed as a means of utilizing the work of existing groups and operating in a ‘joined up’ way. It is further contended that an emphasis on process and on social entrepreneurship can foster the development of community involvement practices in Primary Care Trusts to meet the current and changing health needs of local communities.

Notes

 The plethora of terms and meanings associated with ‘community involvement’ make it necessary to both explore the range and justify the choice of terminology used in this article. It is important to emphasize at the outset that ‘community involvement’ is the phrase of choice. The rationale for this is that ‘patient’ can be regarded as a fairly narrow term which implies a degree of homogeneity whereas ‘public’ can be viewed as too broad a label. The binary association between ‘public’ and ‘private’ can also be seen to be unhelpful in this context. It is possible to assert that terms such as ‘population’ or ‘populations’ perhaps more fully reflect the diversity of interest. However, the association with epidemiological studies can be seen to deflect attention away from the focus of this article. It is also acknowledged that the word ‘community’ can be regarded as a far from straightforward concept as it misleadingly implies consensus, similarity of interests and cooperation. However, when used in the sense of ‘local communities’ it can be seen to have relevance for a discussion of Primary Care Trusts, which is perhaps lacking in the other terms.

 It has to be acknowledged that ‘empowerment’ is a concept that can be used to support a variety of diverse and contradictory agendas. There is debate about whether ‘empowerment’ is a process or an entity (e.g., Oliver, 1996). Some writers have used it to refer to various kinds of participative processes (e.g., Lewis & Glennerster, 1996); others, such as Braye and Preston-Shoot (1995) and Mullender and Ward (1991), from differing perspectives have clearly coupled anti-oppressive and ‘empowerment’ strategies.