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After reading "The global primary care crisis," the shortage of primary care physicians becomes challenging as many new graduates opt in for specialization, ultimately creating a global deficiency of well-trained primary care doctors and an elevated burden on primary care services.¹ Outliers influencing this trend are ageing populations, increasing chronic disease rates, and a shortage of primary care doctors.² The healthcare system in primary care is overwhelmed, leading to decreased quality of care and higher patient costs. Healthcare providers often overlooked are naturopathic medical doctors (NMDs) in the United States who are medically trained professionals offering various modalities to treat acute and chronic conditions; these doctors are a solution to lessening the burden of an overstretched system, including decreasing payer taxes, as not all Insurance companies support NMD's.³
"We encourage researchers, clinicians, stakeholders, and policymakers to recognize naturopathy as a sophisticated model of whole health delivery in the primary care setting."³ Good practice management requires a continuous and collaborative effort from healthcare administrators between primary care providers to ensure continuity of care and improve patient outcomes. Continuously evaluating healthcare processes reveals opportunities for improvement. It is essential for not just communication but transparent communication between...
"We encourage researchers, clinicians, stakeholders, and policymakers to recognize naturopathy as a sophisticated model of whole health delivery in the primary care setting."³ Good practice management requires a continuous and collaborative effort from healthcare administrators between primary care providers to ensure continuity of care and improve patient outcomes. Continuously evaluating healthcare processes reveals opportunities for improvement. It is essential for not just communication but transparent communication between patients, healthcare providers, and administrators.
Smaller qualitative studies may be beneficial to identify what is specific to a particular community. This data could be used to analyse healthcare processes, services, and outcomes, ultimately informing decision-making and improving quality - ensuring that healthcare services and procedures comply with legal, ethical, and regulatory requirements. In a 2019 observational study, the UK ranked lower in spending with a decreased growth in expenditure with low labour compared to the USA.⁴ Outliers included lower levels of doctor and nurse staffing and less long-term care need, resulting in less quality of care.
References
1. Lawson E. The Global Primary Care Crisis. Br J Gen Pract 2022;73 (726): 3.
2. Steel A, Foley H, Bradley R et al. Overview of international naturopathic practice and patient characteristics: Results from a cross-sectional study in 14 countries. BMC Complement Med Ther 2020;20(1): 59.
3. Sadowski A, Garofalo L, Welsh A, Bradley R. Naturopathic doctors: An underutilized resource of whole health delivery in primary care. Glob Adv Health Med 2022;11: 2164957X221079787.
4. Papanicolas I, Mossialos E, Gundersen A, Woskie L, Jha AK. Performance of UK National Health Service compared with other high-income countries: Observational study. BMJ 2019; l6326.
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 re...
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.
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