In the 13 November 2008 issue of the New England Journal of Medicine included an article by Dr Martin Roland, director of the National Primary Care Research and Development Centre in Manchester. He writes: “U.K. primary care physicians increasingly work in multidisciplinary teams, with nurses taking on an increasing proportion of the work. Nurses see patients with minor illnesses and assume responsibility for the routine management of chronic diseases. …
“Having a single-payer system also means that U.K. primary care physicians hold each patient’s lifelong record, which includes a letter regarding every visit to a specialist [and/or hospital]. Virtually all primary care physicians use electronic medical records, and laboratories now generally download lab results directly into family practitioners’ computer systems. Again, the government took advantage of having a single-payer system to define common standards to which all suppliers of electronic medical records must adhere.”
While there are a great many problems with a government sponsored health system (just read of the tragedies in the UK press), the UK primary care capabilities are compelling (note: the government contracts with GPs, they are not government employees). Specific lessons learned for the US consideration include:

• Expanding the primary care workforce by utilizing care workers with training appropriate for the care service to be delivered
• Placing standardized EMR capabilities in the care setting where 80% of care is delivered;
• Standardizing transactions for exchanging electronic health information between GP EMR systems;
• Like the US, the UK has highly variable implementation of EMR capabilities in the hospital setting, but is addressing with their National Programme for IT (NPfIT).

What benefits could accrue if UK lessons were heeded:

• NHIN would draw on a larger repository of health information;
• Better information for outcome driven performance management & reimbursement;
• New generation of care workers who would be prepared for delivering care based on electronic health information (e.g., telemonitoring).

Bottom line, a key tenet of transforming healthcare needs to be focused on care workers, information systems, and outcome based performance management in primary care.