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The UK National Health Service has long delivered public health programs through primary care. However, attempts to promote Sidney Kark's model of community-oriented primary care (COPC), based on general practice populations, have made only limited headway.
Recent policy developments give COPC new resonance. Currently, primary care trusts are assuming responsibility for improving the health of the populations they serve, and personal medical service pilots are tailoring primary care to local needs under local contracts.
COPC has yielded training packages and frameworks that can assist these new organizations in developing public health skills and understanding among a wide range of primary care professionals. (Am J Public Health. 2002;92: 1721-1725)
THE EXPERIENCE OF community-oriented primary care (COPC) in the United Kingdom includes the most comprehensive attempt since 1997 to embed the principles of COPC in the "new National Health Service" (NHS) emerging from the Labour government's reforms.
Despite a predominantly biomedical and humanist focus, general practice in the United Kingdom has long been infused by knowledge and skills traditionally associated with public health medicine.1 The conceptual basis of COPC can be recognized in the writings of Will Pickles describing the use of epidemiology in his rural practice in the 193 OS.2 Likewise, the Peckham Pioneer Health Centre, established before the Second World War by G. Scott Williamson and Innes Pearce,3 has been seen as an antecedent. The philosophy of the center involved protecting good health through a combination of individual and family assessment and provision of a supportive environment.4
Throughout the past 30 years, there have been eloquent pleas for closer working relationships between public health and primary care professionals. At one extreme, arguments have advocated the total usurpation of public health doctors' work by general practitioners.5 Most have envisioned the emergence of a hybrid: the "community general practitioner." Julian Tudor Hart has been the most visible exponent of something akin to Sidney Kark's COPC in the United Kingdom. In a series of painstaking studies, he demonstrated the impact of "anticipatory" approaches to the management of cardiovascular risk factors on his practice population's health.6 His practice, located in a Welsh mining village, took responsibility for both community and clinical functions and held itself accountable to the population served through such means as patient committees, annual reports,...