Editorials

vices to health services with patients falling through the gap which has been created.'4 A recent House of Commons committee report highlighted the potential conflict explicit in the reforms between the downward pressure on the budget of social care (previously there was an open-ended commitment to those claiming income support) and the increasing demand on services resulting from detailed assessment and identification of patients' needs.'5 What of the future? How can the main aims of the community care reforms to make the services more responsive to the needs of patients and their carers and to improve the overall quality of community care be achieved? And what role should the general practitioner play? First, there is a widely recognized need for closer collaboration between health and social services if the reforms are to succeed' and some concern that this may be difficult to achieve.'3 Problems in inter-agency working are not new and have been attributed to a number of factors including differences in the structure and working practices of the NHS and social services and in the occupational culture of health and social care practitioners.'6 The lead up to the reforms certainly highlighted the inadequacy of communication between social services departments and general practitioners, both in terms of collaborative planning and day-to-day telephone access and face-to-face contact.5'6 Ways of promoting greater collaboration are being developed. Joint commissioning of health and social care is happening in some areas; the Lyme community care unit has been set up by general practitioners'7 and a fundholding practice has established contracts with their social services department.'8 Alternative strategies are the linking of care managers with general practitioners' surgeries and the attachment of social workers to practices. However, these initiatives are localized and involve the minority of general practitioners and patients; it is to be hoped that they are being evaluated and that the results will be widely disseminated. How can greater collaboration with social workers be achieved by general practitioners in general? Both groups need to make opportunities for more face-to-face meetings; a named contact in social services for each practice and social workers becoming members of the primary health care team are possible way of achieving greater collaboration.6 An understanding of each other's culture and methods of working are clearly important and could be promoted by joint education and training, secondment of social workers to general practices and members of primary health care teams to social services departments for short periods of time. The community care reforms provide an opportunity for improving the quality of care for users and their carers for whom the divide between health and social care needs to be bridged. Restructuring the way in which care is delivered, closer collaboration between health and social services practitioners and the provision of adequate resources are key components of improving the quality of care in the community. MARGARET LLOYD