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Feature Primary care

China’s plan for 500 000 new GPs

BMJ 2018; 363 doi: (Published 26 October 2018) Cite this as: BMJ 2018;363:k4015
  1. Flynn Murphy, freelance correspondent
  1. Sydney, Australia, and Beijing, China
  1. flynnpmurphy{at}

How to create primary care from scratch. Flynn Murphy reports

China has big plans for primary healthcare. The nation’s policymakers want one general practitioner for every 2000 residents by the year 2030—which means training 500 000 GPs in 12 years to more than triple the current GP workforce.

The aim, says Chen Qi, associate professor of medical history at the Peking University Health Science Center, is to relieve pressure on top tier hospitals crammed with patients who often travel great distances for medical care. “Because of the disparity in healthcare quality, patients lack trust and confidence in local primary care centres,” he told The BMJ.

Building a general practitioner cohort 10 times the size of the UK’s is no mean feat for a nation that started training GPs less than 30 years ago.1 Training quality varies widely, and poor pay and low prestige can make the discipline unattractive.

But don’t doubt China’s capacity to meet staggering targets, says KK Cheng of the University of Birmingham, who researches the Chinese primary care system. Quality is a different matter. “I can guarantee you won’t get uniformly high quality care,” Cheng told The BMJ. But unless the new doctors are “very, very bad,” he said, “what they provide will still be better than what the populace now gets in busy hospitals.”

Lessons of history

Healthcare in the world’s most populous nation has long been the art of the possible. Soon after China’s communist revolution of 1949, a cooperative medical scheme aimed to extend basic care to the rural poor (then 90% of the population).2 Chen Qi told The BMJ that this restarted earlier healthcare efforts disrupted by the Sino-Japanese war. By using paramedics as the first tier of a three tier system, it brought basic but effective and affordable services to rural China. …

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