Two days of Value-based Primary Care

25 February 2021

Written by Prof Federico Lega and Dr Antoni Peris, trainers of the executive workshop on ‘Value-based primary care’.

Primary care has been identified as a priority for health systems since the WHO Alma-Ata Declaration of 1978. Yet, most health systems have struggled to build their primary care systems, as hospitals have continuously dominated the scene. Demographic changes and professional shortage are pushing health providers to consider new ways of organising care services. In the recent Astana Conference, the WHO confirmed the critical role of primary care and its relevance as a cornerstone for the whole healthcare system. This leads to pondering to what extent primary care services can fully or even partially, solve problems detected in communities. Different models have evolved in western countries; nevertheless, the persistence of solo practices or doctor-centred services are at stake. Now, times are mature for a revolution, with the knowledge and capacity to build and manage reconfigured primary care systems. This appears to be the only chance to make health systems really sustainable, and more effective in delivering value for patients, communities and societies.

In the two-day workshop, the latest frameworks and experiences on how primary care systems have been and need to be developed in modern health systems were presented and discussed. Participants looked in-depth at concepts and actions connected to new roles for healthcare professionals, population health management, chronic care, personalised care, patients’ experience, co-creation and co-production of health services, intermediate care, and continuum of care.

Specific focus has been placed on how new paradigms are emerging in the ‘new normality’ of health systems also considering the COVID-19 pandemic, and how they are translated into practice, looking for services in a dual-track, answering both the needs of those affected by the virus and the rest of community and chronic patients. That means the active engagement of general practitioners, nurses and other health professionals working in community services: from Starfield’s Primary Care essentials to Bodenheimer’s building blocks, from solo practitioners to multidisciplinary and multi-professional teamwork, managing patients as clients and new meanings to patient-centeredness. Comparison of experiences has been discussed, with a specific focus on the Catalan case of CASAP and the Italia Lombardy Region experimental reform based on proactive population health management, Chronic Related Groups (CReGs) and individual care plans.

All in all, the workshop has highlighted the ‘renaissance’ that primary care is having and should have in all health systems, as it could be inspired and deeply transformed by the new paradigms that are emerging within the health sector and so leading the way toward real patient-centred care. Furthermore, it was very refreshing to see how a diverse audience (academia, practitioners, industry, consultants) was converging on the importance of patient experience as the key area for the primary care of the future. Times are now mature to achieve the next level, shifting primary care from being the sum of services delivered by uncoordinated professionals to a system organized around a clear vision and ambition.


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Dr Alexandre Lourenco, APAH - Association of Portuguese Hospital Managers, Portugal

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