Intramural and extramural health care in the United Kingdom

In this article the factors which determine whether health care in the United Kingdom is provided in hospital, at home or through intermediate or shared care arrangements are considered. The following aspects of home health care in the United Kingdom are discussed: continuous ambulatory peritoneal dialysis; parenteral nutrition; cytotoxic therapy; terminal care/pain control; intravenous antibiotics. Pharmaceutical implications of the transfer of the long-term care of the mentally ill, mentally handicapped and elderly from hospital to community settings are also considered. Key changes in the development of pharmacy in the United Kingdom are mentioned and the emergence of a new group, community service pharmacists, is identified.