The need for more primary care treatment capacity combined with a significant shortage of GPs is a major problem for healthcare systems in many countries — and raises much debate.1,2 It is not obvious how our healthcare systems best respond to this problem. Some have pointed to the use of extended-scope healthcare professionals as a possible solution.3 Brooks and colleagues recommend specialist, direct-access, 7-day, integrated, primary care occupational therapy and physiotherapy service to reduce pressure on GPs, reduce referral to secondary care, enhance timely hospital discharge, and keep people independently at home.1
However, creating new healthcare service paths may lead to fragmentation of health care and uncoordinated and overall inefficient service. An alternative strategy may be to increase the capacity in existing structures including general practice clinics, for example, by further incorporating extended-scope professionals and other staff into the clinics. Still, there is a shortage of evidence to support which strategies to pursue. We need to consider the perspectives of 1) patients’ preferences, 2) organisational aspects, 3) health economics, and 4) clinical effectiveness, when we eventually decide how to increase capacity in primary care. Therefore, to support rational decision making on these pressing matters, we need high-quality studies that systematically explore the aforementioned four aspects and inform us how to develop primary care.
- © British Journal of General Practice 2018