Policy Bite: shared principles of primary care

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Ruth Wilson, WONCA North America region president (Canada, pictured at left) and Amanda Howe, WONCA president (UK, pictured at right), write this month's policy bite.

The message

We know the importance of strong primary care as a key component of a high performing health care system. However the terms "primary care" and "primary health care" are often used loosely, and there is a need to define and characterise good primary care. Here are eight principles of primary care, recently endorsed by many primary care and family medicine organizations in North America, for consideration.

1. Person & Family Centered

• Primary care is focused on the whole person - their physical, emotional, psychological and spiritual wellbeing, as well as cultural, linguistic and social needs.
• Primary care is grounded in mutually beneficial partnerships among clinicians, staff, individuals and their families, as equal members of the care team. Care delivery is customized based on individual and family strengths, preferences, values, goals and experiences using strategies such as care planning and shared decision making.
• Individuals are supported in determining how their family or other care partners may be involved in decision making and care.
• There are opportunities for individuals and their families to shape the design, operation and evaluation of care delivery.

2. Continuous

• Dynamic, trusted, respectful and enduring relationships between individuals, families and their clinical team members are hallmarks of primary care. There is continuity in relationships and in knowledge of the individual and their family/care partners that provides perspective and context throughout all stages of life including end of life care.

3. Comprehensive and Equitable

• Primary care addresses the whole-person with appropriate clinical and supportive services that include acute, chronic and preventive care, behavioral and mental health, oral health, health promotion and more. Each primary care practice will decide how to provide these services in their clinics and/or in collaboration with other clinicians outside the clinic.
• Primary care providers seek out the impact of social determinants of health and societal inequities. Care delivery is tailored accordingly.
• Primary care practices partner with health and community-based organizations to promote population health and health equity, including making inequities visible and identifying avenues for solution.

4. Team-Based and Collaborative

• Interdisciplinary teams, including individuals and families, work collaboratively and dynamically toward a common goal. The services they provide and the coordinated manner in which they work together are synergistic to better health.
• Health care professional members of the team are trained to work together at the top of their skill set, according to clearly defined roles and responsibilities. They are also trained in leadership skills, as well as how to partner with individuals and families, based on their priorities and needs.

5. Coordinated and Integrated

• Primary care integrates the activities of those involved in an individual’s care, across settings and services.
• Primary care proactively communicates across the spectrum of care and collaborators, including individuals and their families/care partners.
• Primary care helps individuals and families/care partners navigate the guidance and recommendations they receive from other clinicians and professionals, including supporting and respecting those who want to facilitate their own care coordination.
• Primary care is actively engaged in transitions of care to achieve better health and seamless care delivery across the life span.

6. Accessible

• Primary care is readily accessible, both in person and virtually for all individuals regardless of linguistic, literacy, socioeconomic, cognitive or physical barriers. As the first source of care, clinicians and staff are available and responsive when, where and how individuals and families need them.
• Primary care facilitates access to the broader health care system, acting as a gateway to high-value care and community resources.
• Primary care provides individuals with easy, routine access to their health information.

7. High-Value

• Primary care achieves excellent, equitable outcomes for individuals and families, including using health care resources wisely and considering costs to patients, payers and the system.
• Primary care practices employ a systematic approach to measuring, reporting and improving population health, quality, safety and health equity, including partnering with individuals, families and community groups.
• Primary care practices deliver exceptionally positive experiences for individuals, families, staff and clinicians.

The vision outlined in these Shared Principles of Primary Care will result in excellent outcomes for individuals and families, and more satisfying and sustainable careers for clinicians and staff. It is a vision that is aspirational yet achievable when stakeholders work together.

What was the context that made you write this paper?

These principles are supported by the North American region of WONCA. They were developed with leadership from Family Medicine for America’s Health and the Patient Centered Primary Care Collaborative in the U.S. Over 100 primary care organizations worked on a number of iterations of the Shared Principles. The American Academy of Family Physicians, the largest member organization in the North America region, has played a key role in development. The President, Prof Amanda Howe, is grateful to Dr Ruth Wilson for bringing these forward, and we are confident that they will help members to define and improve primary care in their own place.

Why does it matter for patients?

Countries with strong primary care systems achieve better outcomes for patients and populations, at lower costs. A health care system which has as its foundation accessible high quality primary care is better for patients.

What should FP/GP leaders to do implement it?

The key role of family physicians in primary care needs to be articulated and promoted. Family doctors are committed to the relationship between patient and physician; they bring strong generalist clinical skills to this relationship. They serve a defined patient population and are oriented to the health of communities as well as individuals. Leaders in family medicine need to continue to ensure that family medicine adheres to the principles outlined above, while also championing our key role in the provision of high quality primary care.

Organizations who wish to sign on and support these principles are encouraged to do so here