TY - JOUR T1 - Reforming primary care: innovation or destruction? JF - British Journal of General Practice JO - Br J Gen Pract SP - 43 LP - 44 DO - 10.3399/bjgp12X616463 VL - 62 IS - 594 AU - Chris van Weel AU - Francesco Carelli AU - Clare Gerada Y1 - 2012/01/01 UR - http://bjgp.org/content/62/594/43.abstract N2 - The importance of primary care in any healthcare system is undisputed,1 and many countries are currently engaged in system reforms that aim to strengthen the primary care sector. A variety of factors have triggered this need for reform, most driven by the need to address increasing health costs and the challenges of long-term illness. However, preoccupation on reducing costs may inadvertently reduce the role of the GP to that of financial gatekeeper, rather than the advocate of the patient, and in doing so, remove the very essence of its professionalism, that of trust between the patient and their doctor. Another concern is that short-term financial measures will curtail primary care in developing its full potential. This may cause downstream higher replacement costs: for example in access (with increased demand for emergency services) or in integrated care for people with chronic diseases, leading to higher use of hospital-based care. Such an approach is internally inconsistent with a main objective of health policy, to reduce hospital facilities — a policy built on strong primary care.The forces that drive healthcare reform include the need to deliver evidence-based public health and to address health inequalities, as well as the political imperative to create a market in health care. Healthcare reform may lead to substantially different, and unpredictable, outcomes for primary care; varying from a system of single practices providing comprehensive health care, to the creation of a more comprehensive and integrated system (for example the federated model proposed by the UK’s Royal College of General Practitioners), or a model where multiple providers … ER -