Is British primary care under threat from modernisation?

June 15, 2000

Editorial: Fix what's wrong, not what's right, with general practice in Britain

Several of the proposed changes to the NHS could damage Britain's strong primary care infrastructure, according to editorial this week's BMJ.

University professors from Belgium, Norway and the United States look at the key features of a strong primary healthcare system - continuity of care and a comprehensive financing system - and warn that reform could destroy the backbone of Britain's unique health care structure.

Evidence suggests that the UK system of continuity of care - where every patient is registered with one general practitioner - is cost-effective. Yet proposed reforms, such as dual registration, "cut directly across this evidence," say the authors. Furthermore, the provision of walk-in centres and telephone lines staffed by nurses are likely to be expanded "without evidence that they improve health or are cost-effective" they add. In terms of a financing mechanism, the current system of payment for general practitioners has, say the authors, "served the health of Britain well" and they warn that abandoning this system "could result in less health improvement occurring at the same cost."

"Britain has clearly done something right with its National Health Service" conclude the authors, and they call for the government to consider the evidence before interfering with these fundamental aspects of primary care.

Professor Jan De Maeseneer, Department of General Practice and Primary Health Care, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium Email:


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