Essential Primary Care

Andrew Blythe, Jessica Buchan

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781118867594
• Edition: 1
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

Essential Primary Care aims to provide undergraduate students with a comprehensive overview of the clinical problems encountered in primary care. It covers the structure of primary care in the UK, disease prevention and the management of common and important clinical presentations from infancy to old age. Case studies are used in every chapter to illustrate key learning points.The book provides practical advice on how to consult with patients, make sense of their symptoms, explain things to them, and manage their problems. Essential Primary Care:
•Is structured in five sections:
- The building blocks of primary care: its structure and connection with secondary care, the consultation, the process of making a diagnosis, prescribing, and ethical issues
- Health promotion
- Common and important presenting problems in roughly chronological order
- Cancer
- Death and palliative care
•Gives advice on how to phrase questions when consulting with patients and how to present information to patients
•Provides advice on how management extends to prescribing - often missing from current textbooks
•Contains case studies within each chapter which reflect the variety of primary care and provide top tips and advice for consulting with patients
• Supported by a companion website at www.wileyessential.com/primarycare featuring MCQs, EMQs, cases and OSCE checklists

Part 1
The key features of primary care

CHAPTER 1
The structure and organisation of primary care

Andrew Blythe

GP and Senior Teaching Fellow, University of Bristol

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Key topics

• What is primary care?
• Organisation of primary care in the UK
• What can be done in primary care?

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Learning objectives

• Understand the benefits of a health service that is based on primary care.
• Understand the scope and limitations of primary care in the UK.
• Appreciate how primary care is evolving in the UK.

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What is primary care?

Primary care is first-contact care provided by health care professionals to local populations. Primary care attempts to manage the health needs of individuals within these defined populations in a coordinated, comprehensive and continuous fashion from birth until death. Because patients present with unsorted problems, primary care health care professionals must be generalists who have an expert understanding of the causes of health and illness throughout a person’s life.

In many countries primary care provides the foundation upon which the rest of the country’s health system is built. This is certainly true in the UK. Everyone in the UK is entitled to register with a local general medical practitioner (GP). Once registered, the person is entitled to consult with a GP or nurse in the practice to which that GP belongs as often as they like. Most of the time, the GP is able to manage the patient’s problem within the primary care team. Sometimes, the GP needs to refer the patient to the next tier of the health service – secondary care – for further investigation and treatment. In so doing, the GP acts as a ‘gatekeeper’ to the rest of the National Health Service (NHS), ensuring appropriate use of more expensive secondary care services, which are normally based in hospital.

The importance of primary care

The importance of having a strong primary care sector in every country was highlighted by the World Health Organization (WHO) in 1978 at an international conference at Alma-Ata, in what is now known as Uzbekistan.¹ The Alma-Ata declaration set out the aspiration of providing health for all by a primary care-led service. Here is its definition of primary care:

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self-determination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

Article VI, Alma-Ata Declaration, WHO, 1978¹

The aspirations of the Alma-Ata declaration have not yet been fully realised, but many countries are attempting to improve the health care that they offer their citizens by building a stronger base in primary care. China, for example, aims to train a further 300 000 GPs over the next 10 years, so that there will be 1 GP for every 3000–5000 people.²

The last 2 decades have seen the publication of a lot of evidence suggesting that countries which have a strong primary care sector have better health care outcomes. Professor Barbara Starfield, from the Johns Hopkins School of Public Health in the USA, published a seminal paper on this topic in 1994,³ in which she ranked developed countries according to their health care outcomes and the strength of their primary care services. Countries which had the most developed primary care services had the best health care outcomes. The USA, which had the least developed primary care system at the time, had the worst health care outcomes. In the same paper, Professor Starfield showed that the countries which spent the least per capita on health care were the countries which had the most developed systems of primary care.

A more recent analysis of data from 31 European countries⁴ has confirmed that health care outcomes are better in those countries which have a strong primary care base, as measured by the density of primary care providers and the quality of their environment. However, this analysis has not confirmed that these better outcomes are provided more cheaply. Today, countries in Europe which have well-developed primary care services tend to spend a larger proportion of their gross domestic product (GDP) on health than countries with less robust primary care services. According to the World Bank, in 1995 the UK spent 6.8% of its GDP on health; by 2012, it was spending 9.4%.⁵

Knowing t...

Table of contents

• Cover
• Title Page
• Table of Contents
• Contributors
• Foreword
• Preface
• How to use your textbook
• About the companion website
• Part 1: The key features of primary care
• Part 2: Healthy living and disease prevention
• Part 3: Common presenting problems
• Childhood
• Early adulthood
• Middle and old age
• Part 4: Cancer
• Part 5: Palliative care and death
• Index
• End User License Agreement