Primary care practitioners
Primary care practitioners are the cornerstone of any health system. They have a role in prevention, diagnosis, patient engagement and supported self-management, treatment and palliation. They can work with populations and with individuals. The principles, values and health economics of primary care have been fully described by the WHO (see Further reading).
The current variation in access to primary care, and the increasing divide between the growth in numbers of general practitioners and specialists is unacceptable. According to a report produced by the Office for Economic Cooperation and Development (OECD), there are more specialists than generalists in most European countries, with the exception of Romania and Portugal. Yet the existence of easily accessible, person-centred primary care is associated with a more equal distribution of health in populations that do not necessarily benefit from an overabundance of specialists. In cash-limited health systems, the priority should be an adequate supply of primary care practitioners who diagnose and treat disease early and refer effectively to appropriate specialists. Literature reviews have shown that inappropriate referrals to specialists lead to more tests, an increase in false-positive results and poorer outcomes than appropriate referrals. While in many European countries the primary care model is general practitioner-led, this is not the case in many other countries, where nurses, physiotherapists or other healthcare workers take the lead. The model chosen is less important than the quality of the intervention and the belief system that drives it. The value of the consultation must be to enable patients and their families to be active partners in their care and to recognise the likely existence of multiple comorbidities, particularly in older patients. In some countries, a primary care team provides the necessary skills; in others, individual practitioners have to display a wider range of diagnostic and enabling competences.