Primary care: core values Core values in a changing world

This is the first in a series of six articles reflecting on the core values that will underpin the development of primary care In 1920, the Dawson report advocated a population based approach to the organisation of health services, the allocation of resources, and the training of health care staff.1 It also introduced the concepts of primary and secondary levels of care and of primary care health centres. For several decades these ideas lay dormant, until medical specialisation, fragmentation of health services, and the introduction of publicly funded health care made their logic inescapable. The term “primary care” became common coinage, and in 1978 its fundamental importance was recognised by the World Health Organisation.2 In the same year, the US Institute of Medicine identified the four essentials of good primary care as accessibility, comprehensiveness, coordination, and continuity.3 For most of this century, the typical primary care professional has been a generalist practitioner,4 usually practising close to the population served by the practice, alone or in a small group, and supported by a small staff. (Generalist practitioners include practitioners from nursing and from general paediatrics or internal medicine.) The key relationship for most of these practitioners is with individual patients who consult about problems they have identified themselves. Until recently, screening for risk factors and early disease in asymptomatic patients has been unusual. But practitioners have often forged strong community links, especially in small towns and rural areas. For all its limitations, generalist practice has represented a strong tradition of personal care, comprehensive in its response to the needs of the people and reasonably accessible in their neighbourhoods and homes. It is on this living tradition that primary care should build as it evolves into new forms. Traditions are the bearers of values. In a living tradition, …