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    I wonder if Croaky actually critiqued the article by Thomas Aschenbrener? Apparently nurses will take over primary care with doctors mostly becoming specialists. Surely this would be a huge expansion of tertiary care? Especially since NP’s have a restricted, defined scope of practice, it would result in less health problems being dealt with in primary care and more in the tertiary setting. Surely we should be aiming for the opposite? With an ageing population and chronic disease increasing, I would think the demand for doctors with generalist skills will (and should) increase.

    And (in Australia), we have a large increase in medical student places about to hit the system, a lot of whom will be funnelled into GP. This will, in the future, result in an expansion of the GP workforce (as opposed to it decreasing significantly, as proposed by the article).

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    In some way, this information may be useful to this discussion. I have a set way that I teach the difference between these two to nursing students (often via flexible learning methods). I have been using this in writing educational materials for many years…
    It goes like this:

    I ask the student to outline some of the differences and similarities you are able to identify between Primary Health Care provided by General Practitioners in Australia and the WHO Primary Health Care definition.

    WHO Primary Health Care
    First level of contact with systems relating to health
    Universally accessible to all members of a community
    Occurs within day to day issues in life

    General Medical Practitioner Services
    First level of contact with systems relating to health care
    Universally available to those with Medicare Card
    Occurs within specific settings

    I start out with these and ask them to add what they think. Just FYI.

    For what it’s worth…

    WHO Primary Health Care General Medical Practitioner Services
    Full participation encouraged. With some, the passive role can be encouraged.
    Close to where the people live and work


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