ABSTRACT
Health care systems are of three types: those which have no consistent structure, those which are based on a mixture of primary and specialist care, and those which are based on comprehensive primary care provision. Primary care acts as barrier to patient entry into the specialist health care arena and it reduces costs mainly by limiting access. The World Health Organization, in its espoused global strategy for health—widely misquoted but known as 'Health for All' — adopted the principles of the Alma Ata declaration. Despite the central importance of primary care to the ethos and practice of the National Health Service (NHS), and its value in controlling overall costs of health care to the government, health policy pays relatively little credence to primary care interests. Paradigms have been blown apart in many industries, services and professions since the Thatcherite reforms took root in the early 1980s, but there had been relatively little impact on the NHS until the 1991 reforms.
