Provider perspectives on general practice in Henan, China: a mixed-methods study

Zhu, Jiming; Ariana, Proochista

Theoretically, it is easy to understand that comprehensiveness and first-contact care requires GPs to deal with a much larger variety of problems, while specialists focus in depth in one clinical domain. However, in practice, some work of GPs may inevitably overlaps with many specialists, especially from an international perspective. In the UK, the primary care doctors are GPs, while in the US they consist of family physicians (US equivalents of GPs), general internists, paediatricians, obstetricians and gynaecologists. Furthermore, many attributes of GPs such as comprehensiveness, continuity, first contact and coordination are all relative concepts -sometimes they do not necessarily and automatically distinguish GPs from specialists. For instance, some specialists with an office-based tradition in the US (such as some cardiologists and pulmonologists) actually identify themselves as primary care physicians, 22 and some research recognises the important contribution of specialists to primary care -in particular 58.2%, 43.8% and 42.3% of the care provided by cardiologists, gastroenterologists and pulmonologists, respectively, is classified into the category of principal care which has the evidence of continuity and comprehensiveness. 23 Conversely, GPs can work in tertiary hospitals. In Canada, 90% of the hospitalists (providing comprehensive care for inpatients) are GPs. 24 Moreover, the broad care provided by GPs may overlap with allied health professionals such as nurses and community health workers. In the UK, the consultations in general practice undertaken by nurses increased from 21% in 1995 to 34% in 2006; more responsibilities previously undertaken by GPs are taken over by nurses. 21 All in all, the work delegation and substitution indicates that there are potentially various combinations of health workforce (GPs, specialists, allied health professionals, etc.) to deliver PHC. Depending on these different combinations and different health delivery systems, different countries actually demand different things from general practice, as reflected by the large variation of the proportion of GPs as a percentage of each country's total number of doctors: UK 60%, Canada 51%, France 50%, Spain 37%, Netherland 33%, Finland 32%, Denmark 25%, USA 20%, Germany 19% and Sweden 10%. 25 26 No research so far has proposed a convincing gold standard establishing the 'ideal' proportion of GPs. Accordingly, it becomes so complex and confusing in China when such a large and diverse country in transition learns the "successful" experiences across various countries. Also, more special in China is the role of TCM. This paper does not want to enter the endless debate of western medicine vs. TCM or want to deny the potential huge contribution of TCM to PHC. We just find that at this stage TCM further compromises the understanding of general practice in China. Recognising the reality, instead of the obsession with GPs, it is probably better for China to develop its own multi-professional team-based approach to deliver PHC. The 'team' can involve GPs, other generalist physicians, nurses, and even nurse practitioners (very new to China), etc. Obviously, this team-based approach can also accommodate TCM practitioners very well.