Primary care and health care reform: the need to reflect before reforming

The system of primary care in the UK National Health Service appears to have become popular amongst policy makers worldwide. This is surprising given the poor knowledge base regarding the care provided and its cost effectiveness. It is necessary for policy makers to identify which health care interventions are effective and cost effective, and develop knowledge about how behaviour can be changed and cost effective interventions adopted in routine medical practice. Trials of pharmaceuticals in primary care therapeutic areas reveal a poor knowledge base about clinical effectiveness and often fail to include economic aspects. Initiatives such as the UK general practice fundholding scheme, the general practitioner contract and the Health of the Nation targets were not based on empirical evidence and have not been subject to adequate evaluation. If health care reforms elsewhere are to include emphasis on primary care, policy goals must be clearly articulated and the knowledge base informing efficient delivery of primary care must be improved.