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Primary care is key to optimising value in healthcare

Press release issued: 14 November 2017

Balancing improvements in health against the cost of such improvements in primary care is vital to achieve a cost-effective and efficient healthcare system, finds a new report led by University of Bristol researchers and published in the BMJ.

Healthcare systems across the world are under immense pressure to deal with ageing populations alongside increasing numbers of patients with chronic diseases and multimorbidity. With finite resources, and an increasing recognition of the potential harms to patients of over-diagnoses and over-treatment, it is essential that resources are used optimally.

Researchers from the Centre for Academic Primary Care at Bristol Medical School highlight how NHS reforms can increase or decrease value and optimality in primary care. For example, reforms which aim to increase seven-day working in primary care may have knock-on effects on continuity of care, which has been shown to be associated with reduced hospital admissions. While population level reductions in risk factors for cardiovascular disease led to large improvements in cardiovascular mortality, expanding indications for treatment to include low risk people with mild hypertension may take us beyond the point of optimality. Reforms also require adequate investment. For example, developing new multi-professional roles such as physician assistants requires senior mentoring and support and can take several years to reach full potential.

Dr Jessica Watson, the report’s lead author and NIHR Doctoral Research Fellow in the Bristol Medical School, said: “Primary care in England is buckling under increasing demands - for example, more seven-day working, more consultations to take pressure from accident and emergency departments, more to tackle obesity, and more to screen for dementia. To achieve high value, primary care should also consider what low value activities to do less of, as well as what to do more of. Primary care is key to optimising value in healthcare; if primary care is not strengthened, secondary care could face even greater demands.”

The report recommends that policy changes are evidence-based and trialed or piloted before implementation alongside improved data and primary care systems to measure the impact of policy interventions. This would help policy makers decide where to focus scarce resources, where they will deliver most benefit, helping manage increasing demand within financial constraints, and reduce over-diagnosis and over-treatment.

Professor of Primary Care, Chris Salisbury, the report's joint author, added: "GPs are busier than ever and under pressure to do more. Each new demand has a knock-on effect. More time spent working at the weekend means less time during the week to manage chronic diseases, which reduces continuity of care. New health policies need better evidence to balance the improvements in health against the costs of these improvements.”

Further information


Better value primary care is needed now more than ever’ by Jessica Watson et al. Published in the British Medical Journal (BMJ). November 2017.

The paper was commented on in the BMJ's 'Editor's Choice' in the same issue. See 'Towards the new frontier' by Fiona Godlee. Published in the BMJ. November 2017.

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

About Bristol Medical School

Bristol Medical School comprises two departments:

The school's mission is to deliver excellent research, focused on improving the health of individuals and the population, and to develop the next generation of clinicians and scientists.

Our vision is to develop our world-leading reputation for health research, and embrace educational innovation that will nurture skilled, adaptable and resilient clinicians and scientists, through our undergraduate and postgraduate teaching, and our research.

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