Intended for healthcare professionals


Unfulfilled potential of primary care in Europe

BMJ 2018; 363 doi: (Published 24 October 2018) Cite this as: BMJ 2018;363:k4469
  1. Luke N Allen, GP academic clinical fellow1,
  2. Shannon Barkley, technical officer2,
  3. Jan De Maeseneer, emeritus professor3,
  4. Chris van Weel, emeritus professor of general practice45,
  5. Hans Kluge, director6,
  6. Niek de Wit, professor7,
  7. Trisha Greenhalgh, professor1
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
  2. 2Primary Healthcare Services, WHO, Geneva
  3. 3Department of Family Medicine and Primary Health Care, Ghent University, Belgium
  4. 4Radboud Institute of Health Sciences, Department of Primary and Community Care, Radboud University, Nijmegen, Netherlands
  5. 5Department of Health Services Research and Policy, Australian National University, Canberra, Australia
  6. 6Division of Health Systems and Public Health, WHO Europe, Copenhagen, Denmark
  7. 7Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
  1. Correspondence to: L N Allen luke.allen{at}

The Alma Ata declaration’s compelling vision of health for all will not be realised until we take community level prevention seriously, argue Luke Allen and colleagues

To mark the 40th anniversary of the Alma Ata declaration on primary healthcare in October 2018,1 world leaders gathered in Astana to renew their commitment to health for all. Although primary healthcare is about much more than primary care services, getting this element right is crucial to supporting the overarching principles of equity, population level primary prevention, and action on the social determinants of health. In the context of increasing chronic multimorbidity and ageing populations we consider why European primary care has broadly failed to engage with the prevention oriented approach set out 40 years ago, and what conditions are required to realise its potential.

Contemporary challenges in primary care

Primary care has been defined as “first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system.”2 A stronger primary care sector is associated with greater equity, better health outcomes, and, in some settings, lower overall costs.34 Primary care can manage 90% of all health system interactions, making it central to the realisation of universal health coverage.56 Over recent decades, improvements in the quality and coverage of primary care have delivered important population health gains around the world.3789101112

Primary care teams are commonly led by family doctors (also known as general practitioners or family practitioners), who have received postgraduate specialty training to provide comprehensive family and community oriented medical care. In recent decades they have come under pressure from substantial increases in workload, including paperwork and delegation of care from hospitals to the community setting.613 Task shifting to primary care is often appropriate, but reallocation of responsibility is rarely …

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