As my one-year post as Visiting Professor in Primary Care Research at CUHK draws to an end, it is an honour to be asked to write an editorial for the Hong Kong Practitioner reflecting on what I have seen and my understanding about Family Medicine and Primary Care in Hong Kong after my year here, and to compare it with my experience of general practice in the UK.

My vantage point has been from the School of Public Health, at the Chinese University of Hong Kong, as an academic mainly tasked with the development and implementation of a Family Medicine and Primary Care research strategy.¹ I have also had a limited role in teaching medical students, having reviewed the undergraduate curriculum and suggested some developments which are now being taken forward. My clinical exposure has been limited to teaching clinics in Family Medicine in the Hospital Authority, so my view is only partial. In this editorial I will not focus on academic work, other than to say two things: rigorous research into primary healthcare is essential to inform and underpin the development of primary healthcare. Comprehensive community-based high quality teaching of undergraduate medical students is also essential to develop the next generation of family doctors. In the UK this has only been possible by Government funding (outside of University funding) which allowed academic departments to recruit and pay GPs to teach students.

The importance of primary healthcare to the effectiveness of healthcare systems and the promotion of public health is now widely accepted. However, countries differ enormously in how they invest in and support primary healthcare. In this first quarter edition of the Hong Kong Practitioner, the Hong Kong College of Family Physicians (HKCFP) Research Committee reports the findings of a large survey² revealing that two-thirds of the Hong Kong population receives their primary healthcare services in the private sector, mainly from private general practitioners (GPs). However, as Li and colleagues point out in another paper in this same edition,3 such GPs are not required to have post-graduate training or qualifications in Family Medicine, often work single-handedly, with little or no direct contact with either secondary care or other healthcare professionals within primary care. Quality and safety of care in the private GP sector is largely unknown as the system is neither regulated nor regularly reviewed.

In contrast, in the UK all citizens have comprehensive healthcare coverage in primary (and secondary) care via the National Health Service (NHS), free at the point of contact, paid for by general taxation.³ Effective primary care is at the heart of UK government health policy. Almost 90% of NHS activity occurs in primary care, helping to contain costs and providing local, accessible, community-based holistic care. GPs are crucial to effective primary healthcare in the UK; since the inception of the NHS they have played a key role in 'gate-keeping' and nowadays provide clinical and organizational leadership to multi-disciplinary teams. All doctors wishing to be GPs must be formally trained in General Practice including gaining membership of the Royal College of General Practitioners (the UK equivalent to Hong Kong's Family Medicine Specialists).⁴

I am not suggesting that Hong Kong should necessarily try to emulate the UK system of primary care and it would also be wrong to suggest that general practice and its role in the development of primary healthcare in the UK has been easy or that all is now perfect-it has been a long slow march and many problems persist. But GPs remain a known, trusted, and valued local resource for patients, within an increasingly quality-assured and patient-centred system, and the RCGP has contributed positively to this evolution over the years.

The HKCFP, in a short space of time, has put Family Medicine in Hong Kong on the map-locally, regionally, and internationally. The College, which depends entirely on the hard work of its members, is to be congratulated in many respects, having developed a programme of specialist training in Family Medicine which is undoubtedly of very high quality. Professional bodies, such as the HKCFP and the RCGP can do a great deal in developing the discipline of Family Medicine/ General Practice, not only by contributing to standards for post-graduate medical education but also by engaging effectively with policy makers. It is important to point out that the UK primary care system has been driven by Government policy and funding; a series of GP contracts over the last 30 years which have financially subsidized the development of group practices and multi-disciplinary working, and more recently the delivery of evidence-based interventions for key chronic diseases; funding for early comprehensive exposure to general practice and primary care in undergraduate medical curriculum; and support for primary care-based research and evaluation including academic support.

Li and colleagues are correct, in my view, when they suggest that a quality framework in primary care in Hong Kong is required, with accreditation of primary care doctors.3 They also suggest that some form of minimum postgraduate training and qualification for such practitioners should be mandatory. Again, I agree though I would pose this issue as a question. What type, duration and standard of training is required to ensure that community-based doctors have the knowledge, skills, and experience to deliver effective and safe general practice in Hong Kong?

As a UK trained general practitioner, I feel my post-registration training (at that time, 2 years in different hospital specialities as a senior house officer and 1 year as a GP Registrar, all full-time) was essential. Perhaps, as with the HKCFP, even a longer period is required to become a full-fledged Family Physician. So how minimal can postgraduate training and education be? Does a certificate or diploma make you a competent, safe, and effective GP? These issues must be explored carefully, as radical changes in government policy and funding would be needed in order to introduce a mandatory system of rigorous full-time training in general practice/family medicine for all western medicine doctors wishing to practice general primary medical healthcare. However, ten years on from Hong Kong's returning to China, radical change is certainly possible, especially given the mainland's new commitment to the development of comprehensive and equitable primary care.⁵ Will the Hong Kong Government grasp the nettle?

As I leave Hong Kong to return to my native Scotland I will watch developments with great interest. Links with colleagues in Hong Kong will continue I am sure, but until we meet again I wish the Journal and College well. May you go from strength to strength.