We thank Dr Burt for his comments and would like to compliment him on his response towards the population's need in precedence over the pursuit of the vertical programme. In fact his experiences underscore the point we make: the importance of comprehensive, horizontal primary care for population health. Burt, in an elegant way, has merged the horizontal and vertical approaches, by using facilities of the AIDS programme to improve overall care in the community. In our view, this should be approached in a structural way, by running disease-specific programmes through community-based primary care, and investing a small part of the programme money to strengthen the structure of integrated, horizontal primary care.
Dr Burt's comments stress also the point of durability. His impressive example demonstrates what highly trained and motivated GPs can achieve even when modest extra resources are made available to primary care. The training of GPs and other primary care providers in the community, and at the same time investing in their ability to provide care, is in all probability the best way to guarantee access to care where it is most needed: out, in the community.
- © British Journal of General Practice, 2008.