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The rise of primary care networks

BMJ 2019; 364 doi: (Published 21 January 2019) Cite this as: BMJ 2019;364:l304

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The invisible gap in primary health care zone—A major concern. Re: The rise of primary care networks

In recent years, the numbers of consultant medical and surgical practitioners have been increasing all over the world while the gap in primary care zone remains wide. The news analysis by Gareth Iacobucci [1] has been applauded by several general practitioners and other associate health care professionals.

The majority of the population in developed and developing countries are concerned about primary care for their general aliments and also for in-house supportive care for frail elderly people. Early diagnosis of common illnesses and preventive care for preventable diseases are high in demand in present day scenario. However, adequately trained primary health care professionals are not available in most peripheral rural areas.

We sincerely appreciate that community networks centered on groups of general practices are one of the major tenets of the NHS’s long term plan in UK [1] which many other countries may follow.

Network of primary medical care units in resource poor underprivileged remote rural zones
Most of the rural areas in India are facing urgent need of primary medical care practitioners. As proposed by the author, we may aim to foster better collaboration among medical practitioners, pharmacists, district nurses, physiotherapists, social care, the voluntary sector, and others to build network around a population where people know one another, and the clinicians working within that area can develop relationships across that area and support one another. [1]

China has pioneered advances in primary health care (PHC) and public health for an immense, diverse population. [2]

With the emphasis on prevention and self-care, the barefoot doctor-based system proved effective in improving overall health outcomes and earned praise from the international community. [3]

In China, most village doctors graduate from middle school or high school and attend adult education or remote education programmes to learn basic medical knowledge for up to 2 years. [3]

To introduce revolutionary changes, we must be very prudent, very careful because this is a very sensitive area [4]

“What we are going to take is a revolutionary concept, but in practice we are using the approach of reform. You cannot make heaven overnight. You need to have a step-by-step approach.”[4]

The increasing burden of NCDs in India is an immense cause of concern, especially in the absence of adequate health facilitates at the primary, secondary, and tertiary levels [5]

Despite expansion of tertiary level health care facilities at city areas in most developed and developing countries, rural areas remain neglected in the 21st century. On every occasion when there is an outbreak of communicable diseases like SARS in China, [5] Swine flu in Singapore, Ebola in Africa, a hue and cry will spread all over the world which dies down after a few months or a year.

The health care market has two phases of evolution, first comes the hospital – for life and death – and second is primary health care center – for day to day care. [6]

1. Iacobucci G. The rise of primary care networks: BMJ 2019; 364 doi: (Published 21 January 2019)Cite this as: BMJ 2019;364:l304

2. Sue M. et al., Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey BMJ Open:

3. Zhang S , Zhang W , Zhou H , et al . How China's new health reform influences village doctors' income structure: evidence from a qualitative study in six counties in China. Hum Resour Health 2015;13:26.doi:10.1186/s12960-015-0019-1.

4. Watts J . Chen Zhu: from barefoot doctor to China's Minister of Health. Lancet 2008;372:1455.doi:10.1016/S0140-6736 (08)61561-5.

5. Pramanik J and Pramanik T. :Post SARS social syndrome?

6. Gera V.: There are many gaps in India’s primary care aggregation:


Competing interests: No competing interests

28 January 2019
Prof. Dr. Jogenananda Pramanik
Professor and Dean & CEO
Prof. Dr. Tanu Pramanik Principal; Dr. Ananya Pramanik, Lecturer., Dr. Azzard C. Comrie, Senior Medical Officer, Stacy Howell, Clinical Laboratory Technologist, Hargreaves Memorial Hospital, Mandeville, Manchester, Jamaica, WI
Careers Abroad Institute School of Medicine, Jamaica, WI
32, Hargreaves Avenue (Hargreaves Medical Complex) Mandeville, Manchester, Jamaica, WI