The Global Primary Care Crisis

January’s Editor’s Briefing and the accompanying editorial by Darran Foo and colleagues accurately diagnose the difficulties facing primary care. From the perspective of the NHS we might add fragmentation of working practices, leading to discontinuity of clinical care and difficulties for doctors, marked variation across the system in ways of working and in quality of care and, in all sectors, less than inspiring management and leadership. In the UK the way that social care is funded and organised is nothing short of a national scandal.

The remedies for this very complex crisis must include not just more and better-targeted funding derived from increased taxation, but a complete rethink of how the NHS shows its staff that they are valued, rather than exploited, and a whole system, long term (and ideally cross-party) strategy, for health and social care. Some of this could be achieved relatively rapidly, by improvements in remuneration for low paid workers and improved working conditions and amenities for all staff. Any impact of training more doctors will not be felt until far into the future, and the NHS has a dismal record in successful whole-system redesign. This makes the suggestions by Foo and colleagues of particular interest – a mechanism to identify, disseminate and assimilate good practice at a manageable level. The Integrated Care Systems in the UK could provide a framework for doing this. Learning from success is a more appealing and relevant approach to system change than waiting for years for the (often unhelpful) results of large scale health services research trials.

In all countries economies are damaged by ill health in the population, including in the healthcare workforce. Interventions which lead to better outcomes and are either cost-neutral or cost-saving deserve attention and investment.