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At the heart of general practice since 1960

Government must invest in general practice now

A few months ago the Audit Commission noted that general practice accounts for eight out of 10 patient contacts within the NHS, but enjoys only fifth of NHS spending. It went on to report that 'growth in spending on general practice has risen by 20 per cent in real terms over the last 10 years, compared with over 60 per cent on hospitals over the same period'.

Yet GPs are the key playmakers of the NHS and determine the workload of hospitals. Their pivotal role should be valued and nurtured. Commonsense as well as research evidence suggests investing in high-quality general practice will produce benefits not only there, but also in secondary care. The opposite is not true.

In a remarkable paper in the British Journal of General Practice in April 2001, Professor Barbara Starfield cites international research evidence that supports these claims.

She points out that countries with strong primary care systems have lower health care costs than those with weaker primary care structures. Greater primary care availability produces a greater effect in disadvantaged areas, so it reduces inequity.

And she reports evidence to show that hospitalisation rates for certain conditions are improved by a higher ratio of primary care physicians to the population, but not by a higher ratio of specialists.

Finally, and intriguingly, patients in the USA with a primary care physician rather than a specialist as their personal physician not only have lower costs of care overall but also live longer.

On a recent visit to the Kaiser Permanente Health Maintenance Organisation in southern California I saw the benefits of investing properly in primary health care. If our Government wants to make a real change in the public's perception of the NHS, and if it wants to improve health care quickly and cost-effectively, it should invest in general practice, and should do so now.

Dr Andrew Willis

Northampton

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