General practice, not hospital care, accounts for most of the health service

The phrase “schools and hospitals” is repeated almost every week. Whether it is in a speech to the Labour party conference, or this week in a speech to the party faithful in north London, the British prime minister's shorthand phrase for “education and health” is always “schools and hospitals.” Perhaps this isn't entirely surprising. After all, about 80% of any healthcare budget goes into secondary care, and the potential for dramatic glory as well as disaster is often concentrated within hospitals.

However, secondary care is not the health service. Far from it. In the United Kingdom about 90% of the work of the health service is carried out in primary care. In one recent year 268 million consultations with general practitioners were made,^w1 and satisfaction rates with general practitioners are high—91% according to a survey organised by the Cabinet Office.^w2 Despite the complexity, importance, and emotional context of consultations with general practitioners, only one formal complaint is made for every 70 000 consultations.^w3

This undervaluing of primary care is puzzling. In the 10 years from 1991 to 2001 the number of hospital doctors in the …