Realising the full potential of primary care: uniting the ‘two faces’ of generalism

RETHINKING THE HOW AND WHAT OF HEALTHCARE DELIVERY

‘If primary care fails, the NHS fails.’¹

Faced with an unprecedented mismatch between presented health needs and resources available, we must rethink both how we deliver healthcare and what care we deliver. Work has already started on the ‘how’: notably with efforts to strengthen access and integration — improved coordination of the comprehensive care needed to meet a diverse range of needs.² It is defining ‘what’ to deliver that is proving more challenging. To address emerging problems of over- and under-treatment associated with the undue specialisation of healthcare,³ we need to strengthen delivery of generalist medical care.⁴ This means that we need to bolster the capacity to decide if and when medical intervention is the right approach for this individual (whole person) in their lived context.⁵ We need to put the intellectual interpretive expertise⁶ of the medical generalist back at the core of our primary healthcare systems.

Our ‘United Model of Generalism’ (Figure 1) recognises the important contribution of both ‘Integrated’ and ‘Interpretive care’ in the delivery of whole person generalist medical care. Here, we describe our framework for primary care redesign and discuss the implications for subsequent actions.

A UNITED MODEL OF PRIMARY CARE

The ‘Systems Axis’ (on the Y axis) describes a continuum from single problem accessible care through to integrated coordinated care bringing different skills and teams together.

The ‘Individual Care Axis’ (on the X axis) recognises a continuum from standardised, replicable …