Making general practice fit for the 21st century

[摘要] For some while it has been customary to argue that good primary care is an essential part of an effective, comprehensive system of health care. Barbara Starfield's work comparing the systems in different countries has supplied convincing objective evidence to support the contention, where countries with poor orientation towards primary care have worse health outcomes.1 The same relationship has been found when comparing the different US states,1 and on a more local scale, mortality rates in English hospitals have been found to be closely related to the supply of GPs in the area.2 Policy experts observing from countries lacking such systems, most obviously the US, bemoan their deprivation in this respect.3 Older doctors and patients lament the passing of the familiar family doctor, who through long knowledge of the patients became a family friend. The difficulty with this vision is that such long-term commitment has become unusual, and erodes through the mobility of both patients and the needs of doctors for career development and adherence to the European Working Time Directive. So unusual that it is now unrealistic to plan a system on the basis of long-term relationships. Worse is the risk that constructing a system on the basis of such relationships sets it up to fail. It is worth taking stock to define what the task should be now, and how we can set about achieving it.

[学科分类] 卫生学