Primary health care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (Institute of Medicine). It is essential care that is accessible to everyone, and includes health promotion, disease prevention, health maintenance, education and rehabilitation (Weel and Kidd 2018). Accessible primary health care is essential to achieving universal comprehensive health coverage.
Family physicians working in primary care improve health. This statement is supported by a large volume of peer-reviewed evidence from North America and around the world. An example is that provided by Barbara Starfield. In her seminal paper, she describes six mechanisms for this positive impact of primary care: greater access to needed services, better quality of care, a greater focus on prevention, early management of health problems, the cumulative effect of the main primary care delivery characteristics, and the role of primary care in reducing unnecessary and potentially harmful care (Starfield et al. 2005).
Family physicians in primary care keep people healthy through a mixture of primary and secondary prevention, timely diagnosis, effective treatment of illness, and coordination of specialist care. A full-time family physician makes 2500 new diagnoses each year including approximately 500 individual diseases (Hodgkin 1979). The average number of consultations per family physician is 5.3 per year (Hippisley-Cox et al. 2007) and patients may present three to four symptoms per consultation (Allander 1974). To care for their patients with these diseases an individual family physician will prescribe 233 different drugs per year representing nearly a third of all available drugs at the time (Bakker et al. 2007). This makes them a unique specialty within medicine. The ability to be able to diagnose and manage so many conditions require specialist training, and continuous education throughout their career.
Community based primary care reduces mortality. An increase of one primary care physician per 10,000 population is associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year (Macinko et al. 2007). Family physicians achieve this by recognizing and diagnosing symptoms early, referring appropriately, in addition to managing chronic diseases effectively. As a specific example the absence of a “established primary care physician” may result in an increased mortality of 25% in patients with lung cancer (Su et al. 2019).
Community based primary care reduce avoidable hospital admissions for both acute and chronic conditions. Thirty percent of hospital admissions are potentially avoidable(Rizza et al. 2007). Each 15 to 20 percent increase in family doctor supply per 10,000 population reduces hospital admission rates by about 14 per 100,000 for acute illnesses and about 11 per 100,000 for chronic illnesses, even after controlling for the degree of social deprivation in the area in which people live, their social class, ethnicity, and limiting long-term illness (Gulliford 2002).
When Family Doctors have too many patients, the care they can provide will suffer. “When general practitioners are relatively overworked the patients whom they send to hospital may be relatively sicker; and in these areas patients are more likely to be admitted as emergencies”. A reduction of 5000 hospital deaths per year was associated with an 8.7% increase in general practitioners (Jarman et al. 1999).
Primary care is cheaper than secondary care. Using a primary care physician compared with using a specialist result in 33% lower annual adjusted health care expenditures. This remains the same even after adjustment for demographics, health insurance status, reported diagnoses, health perceptions, and smoking status. (Franks and Fiscella 1998).