Bringing the Family Medicine Model to China: A View from Guangzhou

Some of the health statistics associated with a country as vast as China can be challenging to comprehend. 100 million people in China have diabetes. 40% of the cigarettes in the world are smoked in China. Non-Communicable Diseases (NCDs) such as diabetes and heart disease cause nearly 90% of the 10 million deaths in China every year.


Primary care services are virtually non-existent in China. With no access to the problem-solving and signposting advice of general practitioners (GPs) people are left to refer themselves to increasingly busy hospital out-patient departments to seek medical advice and treatment directly from specialists. A person suffering from headaches, for instance, must attempt to diagnose their own condition. They will have to decide whether to see a neurologist, an ear nose and throat surgeon, an ophthalmologist, and endocrinologist or psychiatrist, when what they would really benefit from is the holistic, evidence-based, person-centred approach of a GP who knows them.


The Chinese government has recognised that without an effective primary care service, the cost of healthcare in the country will continue to escalate and hospitals will be overwhelmed. In addition, primary care doctors and nurses can and should be the “specialists” able to provide comprehensive services to people with NCDs.


The good news is that with co-ordinated, evidence based primary care services, people with NCDs can live longer, more fulfilled and more productive lives. As a result, there is enthusiasm in China to learn from the approach to primary care provision in Britain where 90% of all patient contact with the health service take place in general practice.


It is in this context that BUPA China is pioneering the development of primary care clinics in the historic city of Guangzhou. BUPA China is about to open its first primary care clinic in the heart of the Guangzhou commercial district and in April 2017 a team from Primary Care International (PCI) ran a week-long training programme for the medical, nursing and pharmacy staff there.


With impressive, futuristic looking skyscrapers visible through the expansive clinic windows, the training focussed on evidence based, holistic, systematic NCD care as well as practical skills such as advising patients on how to use an inhaler for asthma – a surprisingly challenging task. One participant commented, “I have been in practice for twenty years and never tried using an inhaler before!” The sessions on developing consultation skills were particularly well received.


The PCI approach to training was a new experience for those attending the course. On one occasion, the PCI team gave a demonstration, in English, of breaking bad news to a patient which was re-enacted simultaneously in Chinese by course participants. This innovative training session generated a long discussion about the challenges facing health professionals in China where traditionally, bad or significant news is communicated by doctors not to the patient but to their family. The resulting secrecy can have a negative impact on relationships within the family as well as making the patient feel ever more isolated. Those attending the course were glad of the opportunity to actively to develop their consultation skills, enabling them to approach this kind of situation with more confidence. One participant commented, “I have never been to any training like this… Usually trainers stand there and talk and we listen but we are learning new skills with you. I cherish it all!”


PCI is delighted to be able to work with BUPA China on such an innovative programme and will continue to support the project over the coming year with access to clinical resources and mentoring support. There is clearly much work to be done to develop primary care services in China but there is also considerable determination and enthusiasm to do so. At the end of the course, one of the participants summarised what they had learned during the week: “Look beyond the disease to see the patient…. Use evidence-based practice and tools to manage the patient… Look at the best solutions for the patient.”