The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions?

Abstract

Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals’ Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as lower-income countries.

Tackling the primary healthcare workforce crisis: time to talk about health systems and governance. A comparative assessment of the European region

“…This comparative research provides novel empirical insights that contribute to a deeper understanding of the PHC workforce [30] and prompts critical reflections on the practical implications of the PHC principles put forth in the 'PHC primer' [26]. The findings document strong gaps between the global PHC debate and the complex realities of PHC systems and workforce conditions in practice.…”

“…Recent WHO efforts [26] have underscored the challenges in aligning the global PHC-oriented model with national health systems [13], highlighting the need for tailored approaches to fulfil diverse needs and contexts. Others have addressed the 'layered' nature of the PHC workforce crisis and emphasised that the 'causes at the heart of such crisis, and their patterns and implications differ across the very diverse European region' [30]. Longing for a broad and inclusive 'one-size-fits-all' PHC model may risk obscuring these layers and diverse conditions and institutional prerequisites, including powerful professional stakeholders and interests, necessary for effective policy recommendations [12,20,[31][32][33][34].…”

What can we learn from general practitioners who left Spain? A mixed methods international study

“…Building on research findings, we have developed 10 evidence-based health policy recommendations to enhance GP retention and recruitment in Spanish primary care (summarised in Box 3 ). Our findings and recommendations are anticipated to hold significant value and applicability elsewhere in Europe given the shared context of primary care workforce crisis and the growing international interconnectedness of healthcare workforce policy [ 3 ]. Our study also contributes to framing health workforce international mobility as an opportunity to share examples of good practice and suggestions for improvement, while instigating policy learning and transfer across Europe.…”

“…This holds significant implications within an international context marked by rising workforce constraints, especially in primary care, which have been exacerbated by the effects of the COVID-19 pandemic. These challenges pose a threat to the sustainability of healthcare systems, as emphasised by the timely editorial for the special collection on the medical workforce crisis in primary care in Europe, of which this study is part [ 3 ].…”

Crise global da atenção primária à saúde

“…Por vezes, essa disfunção vem acompanhada de um conjunto de políticas conservadoras de austeridade que reduzem substancialmente o financiamento dos sistemas de saúde. [11][12][13][14] No entanto, neste editorial, fala-se em crise global da APS e da MFC, e até o momento foram citados apenas os países mais ricos do Norte Global. Fato é que este debate chama a atenção por ocorrer nos países que servem como referência para a APS de países como o Brasil.…”