Letters to the Editor

"Primary health care, now more than ever": this motto, quoted from the 2008 World Health Organization (WHO) annual world health report ¹, has clearly emphasized the need for primary care as a foundation for any healthcare systems. At approximately the same time, our government has also released the healthcare reform document ² "Your health, your life" that has highlighted the need for promoting and enhancing primary care in Hong Kong.

The Hong Kong Primary Care Office (PCO) was established in September 2010 comprising staff with expertise from the Food and Health Bureau, the Department of Health and the Hospital Authority. According to the Primary Care Development in Hong Kong Strategy Document,³ the PCO's role is to support and coordinate the development of primary care in Hong Kong, particularly the implementation and coordination of actions across different healthcare sectors.

The PCO has already been working on this development through liaising with different stakeholders and exploring future potentials. It has also started organizing seminars to frontline primary care providers, informing them about their vision and strategy in improving Hong Kong's primary care. Furthermore, as most readers may already be aware, applications for the primary care registry have already been activated. With an intention to include different types of healthcare workers into the primary care registry (such as physiotherapists, nurses etc), this registry should prove to be one that encompasses the holistic and multi-professional nature of what primary care should be characteristic.

Despite the efforts made, there are intrinsic flaws with the current development direction.

Firstly, it is understandable to have a wide inclusion for primary care physicians at the initial stage of establishing the primary care registry, with subsequent creation of a stringent set of criteria for defining the indices for high quality primary care. However, promotion of the primary care registry will take place within 2011, at a time when the indices of high quality primary care have not yet been defined. How can the Hong Kong population be sure that whom they are seeing are reflective of what family medicine should be? How can the PCO guarantee that our citizens receive appropriate care?

Secondly, the PCO strategies include improving all aspects of the 5 C's concept of primary care. Undoubtedly these are essential components of any primary care development cornerstones. However, there are as yet no proposed measures as to how these could be carried out. The current heavy workload in public primary care will certainly not be able to cope with such new strategies unless the Hospital Authority (HA) introduces alternative approaches in their service provision. The health insurance scheme, which has yet to gain support from private healthcare providers, may be the way forward if there is greater primary care involvement; nevertheless, this is still in its preliminary stage and may be futile in the long run because of the lack of support.

Thirdly, success in organizational change requires several components, including top level commitment, stakeholder consultation, user involvement, continual learning, alignment and integration. So far there have been minimal frontline consultations. There is still significant service overlap between the HA and the Department of Health which has not been addressed, apart from a very generic "Community Health Centre".

Overall, the future direction of Hong Kong's primary care appears to be going in a positive direction. However, if our initial steps are taken without careful considerations, primary care runs the risk of failing in front of our people's expectation, failing to provide the necessary care for our people, and in the end increasing the health burden of our ageing society.