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Defining primary care sensitive conditions

Primary care is a major component of England’s National Health Service , providing around 300 million consultations per year with GPs in England. In addition to providing healthcare to their patients, GPs are also charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers; a responsibility that will become more important now that GPs will be undertaking the commissioning of health care.

This new responsibility for GPs provides an opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. In a paper published in the Journal of the Royal Society of Medicine, Daniel Gibbons and Colleagues review the evidence on what conditions are most sensitive to management in primary care – commonly referred to as primary care sensitive conditions (PCSCs) or ambulatory care sensitive conditions. Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions.

Inappropriate utilization of secondary care resources is likely to represent a significant opportunity cost to healthcare providers and may be less desirable for patients.  Measuring the rates of  admission for PCSCs is potentially therefore a useful indicator of primary care performance. However, for this measure to be truly representative of what it seeks to assess, not only does there need to be consensus on what diseases – or disease events – are PCSCs, but also agreement of what is within the power of primary care to change.

Key questions for future research include assessment of what proportion of unplanned admissions for chronic conditions are potentially preventable through better patient education, improved health literacy, and higher quality management in primary care; what healthcare factors or interventions can reduce the risk of complications such as unplanned admissions; the effect of practice-level financial incentives on admission rates for PCSCs; and what proportion of these admissions are either unpredictable or outside the control of the health system.

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