Strong primary care can help improve efficiency, says WHO report

Map of Europe with flags identifying each country

Unless it is a medical emergency, primary care services will be the first experience that a member of the general public will receive from the National Health Service. And for that reason, it needs to be efficient, of the best quality, and right for that individual.

Successful primary care can mean that a person does not need to enter the secondary care system, and can have their care managed in an environment that is familiar to them.

This book presents the results of the PHAMEU (Primary Health Care Activity Monitor for Europe) study, which was carried out from 2007 until 2010, and compared primary care services throughout Europe, identifying their strengths, and the challenges that they face.

One hand holding an orange, the other holding an apple

The Primary Health Care Activity Monitor for Europe study compared primary care services throughout Europe

Primary care comparisons

Before this publication, there had been a distinct lack of “comparative information on the structure, process and outcomes of primary care in Europe.

Thirty-one European countries, including the United Kingdom, contributed data about health systems to inform the work, and an evaluation of the differences is presented in this book, mapped by a monitoring instrument developed as part of the PHAMEU project. The book comprises five chapters:

  1. Introduction – this looks at the challenges that health care systems face, and describes what strong primary care is. Communication, leadership and collaboration are fundamental to strong primary care.
  2. Structure and organization – the editors compare governance, policy-making, education, economic conditions, workforce development, and the structure of primary care in the different countries. They found that while there were only small differences between countries, policy did not focus on multidisciplinary collaboration as much as it could. They also found that there was strong variation in spending, and also the development of the workforce.
  3. Service delivery – this chapter compares access, continuity and coordination of primary care, and comprehensiveness of services. It described the differences that people in Europe face when trying to access primary care, including financial barriers, lack of available GPs, varying methods of contact such as email and availability of home visits. It also looked at how data is shared between primary and secondary care, some using electronic health records, and other countries relying on more basic techniques for record management. One aspect that the book looked at to maintain co-ordinated care, was whether or not there was a patient referral to specialist care system in place, also known as the “gatekeeper” role, which usually belongs to the GP. This varied, with some patients having access to most physicians, and others having to go through their GP for referral.
  4. Diversity – in terms of structure, process, strength, and efficiency. The editors concluded that countries with strong primary care had better population health, and that hospital readmission was reduced.
  5. Challenges – the final chapter compares the challenges that primary care services face.

At the end of each chapter, there is a conclusion and a list of useful references, and throughout the book there are informative data tables.

A lifeguard observation tower

This book makes many insightful observations for commissioners


This book makes many insightful observations on what providers can do to improve service delivery:

  • Primary care should be seen as the main access point to all health care services.
  • A range of providers should deliver treatment services so that patients have more options.
  • Continuity of care is important, and therefore partnerships with secondary care providers must be strong.
  • Adequate communication channels are integral to ensure the sustainability of integrated care and satisfaction of patients.
  • Strong leadership is required to ensure that services are co-ordinated, facilitating stream-lined service access.
  • Co-operation between primary care and medical specialists is better in England, compared to some of the other European countries that participated in this research.
  • Home visits are important for ensuring equal access to health services for all, including those who are house-bound.
Shape of a strong person made up of lots of little people

Strong leadership is required to improve service delivery


So why is this document so important for commissioners and providers? The NHS has to make immense savings, while maintaining and improving quality. The provision of the right primary care services can significantly reduce the pressure on secondary care, simply by reducing readmissions and preventing poor health. This is beneficial to the patient and the health service.

Learning from good practice examples in other countries can enhance service provision in England and this is what commissioners can take from this book. Chapter 1 in particular is useful because it describes what strong primary care looks like. As a starting point, commissioners should work with their primary care providers to ensure that their service organisation and provision identifies with the qualities that make strong primary care, taking note of the observations outlined above.


Kringos DS, Boerma WGW, Hutchinson A, Saltman RB (eds.) (2015) Building primary care in a changing Europe: Observatory Studies Series 38. World Health Organization: Copenhagen (pdf)

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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