The last two and a half decades have seen major changes in health care within Eastern Europe and the previous Soviet states, particularly in their attitude to primary care.1–3 Just as the UK is now talking about the emergence of polyclinics to cope with the pressures of primary care,4 these countries have abandoned, or are abandoning the polyclinic concept. Health care, which had previously been founded upon consultations with highly specialised consultants, is now moving towards a general practice/family medicine-led service in community-based, integrated clinics.5
Although the first experience with a primary care system in the region began in Russia in the 1980s,6 major changes in the former states did not occur until the mid-1990s.7,8
Ukraine was one of these former Soviet states that agreed to rationalise its health care, using a model described ably by John Horder (Box 1),9 assisted by experienced UK GPs and ably supported by the Royal College of General Practitioners.10,11
Box 1 Defining a generalist.
‘The personal doctor can offer care which is accessible, of broad range, relatively continuous, and above all, integrative. Not one of these characteristics is easily provided by a specialist; in combination they can only be provided by a generalist. This forms a distinctive role which people value as a basis to which specialist care can be added when necessary. In this way specialists and generalists can relate to each other, not as two people doing the same job, one better than the other, but as two …
