Intended for healthcare professionals


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

BMJ 2000; 320 doi: (Published 17 June 2000) Cite this as: BMJ 2000;320:1616

It has provided better health than government spending deserves

  1. Jan De Maeseneer, professor (,
  2. Per Hjortdahl, professor (,
  3. Barbara Starfield, university distinguished professor (
  1. Department of General Practice and Primary Health Care, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
  2. Department of General Practice and Community Medicine, University of Oslo, POB 1130 Blindern, 0317 Oslo, Norway
  3. Johns Hopkins Medical Institutions, 624 N Broadway, Baltimore, MD 21205, USA

    British primary care is said to be the envy of the world. The spirit of experimentation anchored to a sound foundation of care led by general practitioners provides other countries with examples of accessible services, continuity of care, and innovative payment systems. Although Britain's healthcare statistics are not the best in the world they are far better than expected given the comparatively low funding of the healthcare system and the relatively inadequate systems of social support. Seen from the outside, Britain has clearly done something right with its National Health Service, which is based on and increasingly strengthened by its infrastructure of primary care.

    The key features of a strong, functioning primary healthcare system are the ability to provide continuity of care and a comprehensive financing system. Until now continuity of care has existed in the United Kingdom because every patient is registered with a general practitioner (a patient list system). People thus have the possibility of developing a long lasting relationship with a general practitioner of their choice, increasing the likelihood of satisfaction among patients.1 A relationship based on personal doctoring has multiple …

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