The Future of Primary Care

The chapters in this book are based on the contributions to a conference organised by the Office of Health Economics and held at the Zoological Society of London on 13 September 1995. The various contributions, from many distinguished authors from the United Kingdom, continental Europe and the United States highlight many aspects of the international debate about the future of primary care. In the United Kingdom the government has adopted an objective of a 'Primary care led NHS' and as part of this process, the Secretary of State for Health, Stephen Dorrell, announced in October 1995 a debate on the future of primary care in the UK, in which the Minister for Health, Gerald Malone would tour the country listening to the opinions of people involved in the delivery of primary care. In June 1996, the government's consultation document 'Primary Care: the future' was published. In it the Secretary of State underlines the government's commitment to a 'Primary care led NHS'. The government's document sets out five key objectives for primary care: that it should provide continuity; be comprehensive; be properly co-ordinated so that professionals work together to meet a patient's needs; be the gatekeeper to secondary care; and address the needs of local communities as well as of individuals. The ministerial roadshow also identified five principles for the planning and delivery of primary care services: quality; fairness; accessibility; responsiveness and efficiency. Finally it identified seven areas for action: resources; partnerships in care; developing professional knowledge; information, involvement and choice for patients and carers; securing the necessary workforce and premises; better organisation, including information technology and management support; and local flexibility. It will not surprise readers that the issues emphasised in the governments paper are similar to those discussed in the following eight chapters. For example, in the chapter by Professor Starfield the characteristics of a strong primary care system are discussed. These characteristics she argues are: accessibility; continuity or longitudinality of care; comprehensiveness; and co-ordination, both through better relationships between professionals and through improved use of information technology. Professor Starfield goes on to consider the impact of the GP as gatekeeper on health outcomes and finds, using international comparative data, that not only is a strong primary health care system associated with better health outcomes for its population but is also associated with lower costs. It is therefore concluded that strong primary care is an efficient use of health care resources. We need to put the UK primary care system into an international context. In this book there are chapters looking at three very different models of primary care, in Finland, the Netherlands and the United States, by Dr Makela, and Professors van der Zee and Light respectively. Other important issues addressed in these papers are the future of fundholding by Professor Ham, and the causes of and solutions to low GP morale, by Professor Mant and Mr Towse. In the final chapter, Professor Roland sets out his vision as to how the dangers of fragmentation and the challenges to define and assure quality of care can be met. This book is a contribution to the continuing debate on the future of primary care and I hope readers will find many of the ideas and concepts discussed thought provoking and stimulating.