Boosting new collaborations: Primary Care workshop jointly organised by the China Health Development Research Center at Peking University, and the NIHR School for Primary Care Research at the University of Manchester

On October 18th, 2021, the China Health Development Research Center, Peking University, and the Centre for Primary Care and Health Services Research, University of Manchester (part of the NIHR School for Primary Care Research), jointly held a primary health care workshop. Attendees included more than 40 researchers and students from the two universities, as well as from Imperial College London, York University, University of Warwick, Canada McGill University, University of Toronto, Shandong University, Tsinghua University, Sun Yat-sen University, Shanghai Jiaotong University, Zhejiang University, China Fiscal Science Research.  

The workshop presented the opportunity for these professionals and scholars from the Chinese Academy of Sciences and other academic institutions to connect and conduct in-depth discussions on the issues at the forefront of primary health care systems reform and development, both in China and the UK.  

This seminar was funded by the Peking University International Strategic Partnership Fund. The seminar was hosted by Dr. Ma Xiaochen, Assistant Professor of the China Health Development Research Center.   

The programme included three groups of matched presentations (full programme available here - best viewed on a mobile, please scroll down and keep the audio on:  https://a.eqxiu.com/s/X9j2piD2?bt=yxy) on: 

1. Introducing each health system context;

2. Primary care workforce;

3. The balance of care between primary and other care sectors. 

In the first set of presentations, Professor Peter Bower, Director of the Centre for Primary Care and Health Services Research of the University of Manchester, set the scene by introducing the status quo and the recent development of primary care services in the UK. He highlighted that the UK’s primary health care system has been relatively successful in areas such as vaccination and has relatively high patient satisfaction, as well as describing recent innovations in providing remote primary health care services and the diversification of primary care teams. However, it also faces pressures, such as increasing demand pressures and difficulty in attracting and retaining staff, and challenges in guaranteeing continuity and more personalised care. Dr. Yuan Beibei, Associate Professor of the China Health Development Research Center, then presented an analysis of China's primary health service organization and financing, and pointed out that China is likewise actively promoting the integration of primary and hospital health services and hospitals, as well as the integration of preventive and curative services. 

The second set of presentations focused on the recent changes and reforms of the primary health care workforce. Professor Liu Xiaoyun, Deputy director of the China Health Development Research Center, introduced a cohort-study of a contract-based free medical education programme for rural primary care facilities across multiple provinces in China. The programme was designed to address issues in geographical dispersion of medical staff, particularly to more rural areas in a country with a vast geography. Contract-based medical students have almost achieved full compliance, and nearly 30% are still willing to stay at the grassroots level after their contracted agreement expires. Subsequently Dr. Jon Gibson from the University of Manchester provided an overview of changes in the composition of the British general practice team, highlighting the skill-mix and its impact on primary care related health outcomes. His findings suggested that, of the primary care team, the number of GPs (full-time-equivalent) are the most important factor positively associated with various aspects of health service outcomes. 

The third group of presentations focused on strengthening grassroots services and changing the hospital-centred models, discussing the latest developments in the two countries. Dr. Xu Jin, Assistant Professor of the China Centre for Health Development Studies reported on research on the strengthening of primary health care in county-township telemedicine collaboration networks. He pointed out that China’s telemedicine collaboration network is developing rapidly and the focus of future development should be shifted from building the network to improving its utilization in primary care, as well as establishing a sustainable financing mechanism. The current reform is a lever to further integrate telemedicine into daily service utilization. Dr. Yiu-Shing Lau from the University of Manchester presented his research on the substitution between community, primary and inpatient services, and identified that community care is a weak substitute for hospital and primary care. Primary care and planned hospital services are complements and both community and primary care services are associated with increased system expenditure. 

Finally, Professor Liu Xiaoyun, Deputy director of the China Health Development Research Center, and Professor Katherine Checkland, Director of the Manchester NIHR School of Primary Care Research (NIHR SPCR), University of Manchester, co-chaired the discussion session. Professor Liu Xiaoyun highlighted that the challenges faced by the health systems of China and the UK are at different stages, and the research directions of health reforms between the two sides are also different, despite strong commonalities in terms of focus on integration of care and human resources. Professor Checkland expressed her strong interest in China's large-scale primary health system, and learned from this meeting China’s efforts in organizing and coordinating primary health care. Participants engaged in the discussion noted that China and the UK are both working hard to carry out reforms such as the integration of health services, grassroots health team-based services, attracting high-quality health personnel to serve in difficult areas, and adapting health services to serve an ageing population. There are many common challenges, research questions and methodological approaches, worthy of continuous learning and collaborative research. 

The Peking University China Centre for Health Development Studies (CCHDS) was established in collaboration with China Medical Board (CMB) in 2010. Tapping into the unique multidisciplinary capabilities and rich academic resources offered by Peking University and its partners, the Centre is pioneering a fully modern and international vision in servicing health development and reform in China and the world through academic research, education and training.  

The University of Manchester Centre for Primary Care and Health Services Research is a well-known institution in the field of health policy research and teaching. It brings together general practitioners, psychiatrists, psychologists, sociologists, economists and health service researchers from multiple disciplines.  

The two Centres have previously collaborated through a pump-priming project on primary care strengthening and development of people-oriented integrated health services funded by the UKRI Global Challenges Research Fund, University of Manchester. The two parties also jointly supervise a doctoral student Zhang Yuqi, in receipt of a full scholarship from the University of Manchester Global Challenge Research Fund (GCRF) to carry out a research project on "Strengthening Primary Care and Integrated Health Care for Patients with Multiple Chronic Diseases in China". Dr. Xu Jin serves as external supervisor from Peking University.  

Both centres expressed their strong desire to continue to promote the institutionalization of routine collaboration in different forms, including regularly holding joint seminars around common interests, boosting collaborations towards tackling global primary care challenges. 

By Yuqi Zhang, Jin Xu, Laura Anselmi, and Jonathan Stokes