1 - Introduction

Summary

Background

In a well-developed primary care system such as that in the United Kingdom, health professionals assume long-term continuing responsibility for a registered population of patients, usually of whole families, in community based facilities rather than hospitals, and working in primary health care teams including general medical practitioners, nurses, and other professionals.

Among western industrialised nations those countries with better developed primary care systems in general enjoy lower costs of care, higher patient satisfaction with health services, better health levels, and lower use of medication (Starfield, 1994). These benefits derive partly from the ‘gatekeeper’ role whereby primary care physicians refer only a proportion of their patients to specialists in the secondary care services, and partly from the long-term continuity of care offered by primary care professionals which encourages the development of therapeutic relationships (Freeling & Harris, 1984). In the UK, Ireland, the Netherlands, Denmark, Portugal, and Canada, patient care is largely supervised by general practitioners, and in the United States the government's policy is to increase the number of generalists as a way of increasing the population's access to medical care (Rivo, Henderson & Jackson, 1995).

Changes in health services in the United Kingdom

Through the second half of the 1980s it became increasingly obvious that a radical revision of the focus and organisation of health services was needed in the UK. The costs of the National Health Service were spiralling upwards.