It is easy to take universal health coverage for granted if you were born and raised in a European country, for example. But in low and middle income countries, people often have to somehow find the means to pay out of pocket for their healthcare, regardless of the availability of quality healthcare. Costs can quickly escalate to astronomical figures in case of serious health problems, and if people don’t have the financial means or relatives overseas who can help, they may end up not receiving any care at all or incurring unmanageable debt.

Richard Smith explains in a recent blog how low and middle income countries could create health systems that offer “higher quality, are cheaper, more equitable, more accessible, and more sustainable” than the increasingly unsustainable health systems of wealthy nations through “leapfrogging,” which is the process of “accelerating development through cost effective and scalable solutions.” The key is apparently integrating thousands of existing leapfrogging projects from around the world, like the Clinicas del Azucar (“The sugar clinics” ) in Mexico, which provide care to patients with diabetes and have cut costs of routine care by 75%.

Nigeria, like many other low and middle income countries, would need about 300 years with the current training capacity to have as many doctors as rich nations. But even many prosperous countries like the UK struggle to train enough doctors, particularly GPs, who should ideally comprise around 50% of the medical workforce. According to Richard Wakeford, who has written a thoughtful personal view in The BMJ, it doesn’t help that of the 33 heads or deans of the UK undergraduate medical schools who form the Medical Schools Council, only two are GPs and the remainder clinician scientists. It is perhaps not surprising that medical students usually come across more scientists and hospital doctors than GPs during their undergraduate training, which in turn will influence their choice of specialty.

In fact, 12% of general practice training posts in England remain unfilled in 2014 despite an unprecedented third round of recruitment, with some regions failing to fill around 30% of available positions, according to a news story in The BMJ. Even in London, with all its pulling power to attract ambitious and talented professionals, some posts remained vacant.
Valeed Ghafoord, a UK junior doctor, wanted to become a GP when she was a medical student, but has in the meantime changed her mind. Her account in a rapid response to the aforementioned news article is heartwrenching: “There is not as many incentives as there once were in general practice. As time progresses it also becomes clear that general practice is further developing into a business where cost pressures play a significant part in the health care one provides.”
General practice is also in need of leapfrogging. Any suggestions on how to do it are urgently needed.
Tiago Villanueva is assistant editor, The BMJ.
Competing interests: I work as a locum GP in Portugal and am part of the Portuguese delegation in the European Union of General Practitioners/Family Physicians (UEMO).