A recent editors' blog by Domhnall MacAuley suggested that it is “difficult to see a future for academic general practice.” I propose that the solution lies in the broader discipline of Academic Primary Care (APC).
Academic Primary Care matters. APC is a distinct discipline driving improvement in primary care through education and research. Academic general practice lies at the heart of this wider multidisciplinary community committed to improving whole-person centred primary health care. The APC community lead health service research driving improvements in policy and practice in key priority areas such as antibiotic stewardship and cardiovascular risk management. But APC also tackles the distinct challenges facing the Primary Care community: for example, the need for new person-centred models of acute and chronic care to address problems of treatment burden and ‘too much medicine’. APC supports the redesign of Primary Care through re-engaging with the core principles of continuous, comprehensive, accessible, whole person-centred care.
APC matters because Primary Care matters. Strong Primary Care is associated with efficient, effective and equitable health care; delivering outcomes that matter to today’s health systems. But Primary Care is more than a location in which care happens - health care outside the hospital. Rather Primary Care is a model of health care underpinned by the core components of continuous, coordinated, comprehensive, and accessible person-centred care. But this vision of Primary Care is being undermined by the response of modern services to today’s challenges. A response that the World Health Organisation has described as an increasing emphasis on the “command and control of disease”; with concerns that an over-emphasis on specialist, disease/condition-focused care is contributing to fragmentation of care.
The greatest challenge in the 21st century will be re-designing Primary Care to meet the needs of aging populations with multiple chronic and complex health needs. Disease-centred care is still important, but is also insufficient. APC has innovative solutions to the emerging problems facing today’s health care systems – new models of care, new models of quality improvement, and new ways of building a vibrant workforce. But APC faces its own challenges – many of which are outlined in Domhnall’s blog. So how do we unlock the potential of APC to continue to drive a vision of Primary Care delivering Health For All?
The Society for Academic Primary Care recently outlined its recommendations for achieving this goal. Arguing that a future model of academic primary care needs to retain its place within the university context (including medical education and research), but also take on new roles to support innovation and co-production across the clinical context. APC grew out of clinical primary care – the General Practice community who worked to describe, teach and evaluate the core components of their work. Within Universities, it has grown in to an internationally recognised discipline providing vital leadership to the primary care community. It is now ready to enter the next phase of its development – to take a new leadership role in the strategic leadership of primary healthcare.
We need Academic Primary Care. Now More Than Ever.