The assessments of patients aged 75 years and over that were built into the 1990 contract for general practice have failed to enthuse primary care teams or to make a significant impact on the health of older people. The lack of an evidence base for these checks, and the absence of any training programme for practice staff involved in the assessment of older people, both appear to be important factors contributing to the failure of this approach. Alternative methods for improving the health of older people who are living at home are being sought. This paper describes the use of a model of community-oriented primary care (COPC) to initiate innovative care for older people in four exemplar practices in an inner-city area of London. Pump-priming funding was supplied for a 2-year period by one health authority, with the proviso that all innovation must be self-sustaining. The project was supported by an academic department of primary care, which promoted discussion about objectives and priorities, provided the evidence base for interventions considered by the practices, supported staff and created an evaluation framework, but avoided any prescriptive intervention in the process of innovation. All four practices have successfully identified different problems that need attention in their local populations of older people, and developed different projects focused on particular needs among older people. The effectiveness of the COPC method in promoting change in these practices was sufficient for the health authority to fund a second stage, extending the method to 40 practices over a 2-year period.
