EFPC: European Forum for Primary Care

‘Strong primary care (PC) produces better health outcomes against lower costs. That is the briefest summary of available scientific evidence. By promoting strong PC, the population's health can be improved’ that is the introduction at the front page of the European Forum for Primary Care (EFPC) web site. The aim of the EFPC is to promote PC. What is our responsibility in times of economical and moral crisis that we are facing in Europe? What could our line of action be?

• First of all it is necessary to analyse the consequences of the crisis in terms of health of the population. Maintaining a healthy population is an important component of a healthy economy. The crisis may lead to variation in the type of health care problems encountered in PC. The social impacts of the crisis are mainly rise of unemployment, rise of population at risk of poverty, housing problems, cut in social welfare and health care spending. These problems are in strong correlation with the increase of suicide rate, alcohol abuse, mental health problems, rise of risk of illness, and less likelihood to recovery from disease, rise of all causes of mortality rate. Vulnerable populations are becoming more vulnerable, but also new categories of the population are becoming at risk, specifically young people. Health problems linked to an aging population with multiple chronic health problems may be more difficult to tackle. Besides health inequalities are increasing.

• On the professional or providers side, decrease in health care budgets may lead to increasing cross border migration of PC professionals leaving unattended populations, closing hospitals lead to transfer of health care problems to unprepared PC teams. Health care professionals may also be very challenged by alteration of working conditions, decrease of income or impact on their personal life. The conflicting attitude in the allocation of resources between the health system as an economic sector, and population's health as a resource and priority, may be a challenge for social cohesion and solidarity as a value.

• How can we act at the level we are working, whether as a health care provider, a policymaker or a researcher in PC? Could we actively influence at the European level, keeping health as a priority, urging the right of European citizens to access quality and affordable health care, which means strengthening PC? At the national level could we urge for a good resource allocation that ensures equity of access, encouraging the provision and access to primary health care services? Better access to PC services improves general health, reduces inappropriate use of services, unnecessary use of specialist and hospital care, promotes rational use of drugs and improving health promotion and disease prevention. At the practice level, can we promote better governance to improve cost effectiveness and good working environment of PC services? Promote practice organizations making the best use of workforces, define clear functions of professionals within PC teams, and promote cooperation between them. PC teams must be able to deal with even more complex health problems since the crisis, and adapt to a changing society. This may reduce inequalities, and avoid burnout of health care professionals.

• However, times of austerity also give the opportunity for change. The necessity of efficiency of health care systems may lead to reinforcing their PC orientation and base, to make a better use of resources, introducing adequate changes that may reduce inequalities and be long lasting.

• As an example of action on EU level, the EFPC signed an open letter calling on European leaders to stop cutting essential health and welfare systems and focus on ordinary people living in Europe coping with the dire impact of a financial crisis of which they are the first victims (1). Further discussion will be open in a workshop ‘Primary Care at times of the economic crisis: A challenge for many European countries’ during the EFPC conference in Gothenburg ‘Crossing borders in primary care’ (Monday 3 September—13:30–15:00) (2). We look forward to your input.