ArticleHealth affairs scholar2024
The performance of general practice in the English National Health Service (NHS): an analysis using Starfield's framework for primary care.
Article in Health affairs scholar, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Ambient scribes in general practice - help or hindrance?The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- A scoping review of how the candidacy framework has been used in research on access to general practice.Journal of health services research & policy · 2026Article
- Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Dilemmas in the development of the general practitioner workforce in primary care: a qualitative study in Beijing, China.BMJ open · 2026Article
- Experiences of access to general practice in England: qualitative study and implications for the NHS 10 year plan.BMJ (Clinical research ed.) · 2026Article
- Patient characteristics and degrees of discontinuity of care in Danish general practice: a cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Advanced Access in Primary Healthcare and Its Effects on Emergency Department Utilization: A Rapid Review.Healthcare (Basel, Switzerland) · 2025Review
- Balancing specialist roles with generalist responsibilities in primary care: have we gone too far?Frontiers in health services · 2025Article
- What's been tried: a curated catalogue of efforts to improve access to general practice.BJGP open · 2025Article
- Deepening the construction of family doctor teams through the integration of the "1 + 1" working method: practice and exploration at the Qingling Street Community Health Service Center in Wuhan, Hubei Province.Frontiers in public health · 2025Article
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Authors and funding
2 authors.
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Abstract
General practice in the English National Health Service (NHS) is in crisis. In response, politicians are proposing fundamental reform to the way general practice is organized. But ideas for reform are contested, and there are conflicting interpretations of the problems to be addressed. We use Barbara Starfield's "4Cs" framework for high-performing primary care to provide an overall assessment of the current role and performance of general practice in England. We first assessed theoretical alignment between Starfield's framework and the role of general practice in England. We then assessed actual performance using publicly available national data and targeted literature searches. We found close theoretical alignment between Starfield's framework and the model of NHS general practice in England. But, in practice, its model of universal comprehensive care risks being undermined by worsening and inequitable access, while continuity of care is declining. Underlying causes of current challenges in general practice in England appear more closely linked to under-resourcing than the fundamental design of the system. General practice in England must evolve, but wholesale re-organization is likely to damage and distract. Instead, policymakers should focus on adequately resourcing general practice while supporting general practice teams to improve the quality and coordination of local services.
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