The reform of primary care in Spain in 1984 focussed mainly on skills and knowledge (physician training and working hours) and material resources (new buildings). The reform did not succeed in improving longitudinal care nor did it give primary care physicians greater power, that is, the reform did not increase coordination or strengthen the central role of the family physician in services provision. The lack of longitudinality has persisted over the years since the working methods that encourage it (and its resulting clinical and public health benefits) have not been stimulated. Longitudinality is the personal relationship established over the years between general practitioners and their patients and is defined as (a) care by the same family physician of most of the patient's problems throughout his or her life, and (b) the recognition by patients and the population of a stable source of care to be used for initial contact and for the follow-up of problems. The tendency in the medical profession and society at large is to respond to an increasing number of health problems more quickly and intensely, with increasingly powerful means and with a greater number of specialists. In turn, this tendency makes medical activities dangerous. To counteract this tendency, a motto of "less is better" should be adopted, implying greater longitudinality. Many initiatives could improve longitudinality, such as incentives for not moving, increasing the capitation component of remuneration to nearly 50%, broadening the range of general practitioners' skills, including family members in the same patient list, and transforming the role of specialists into that of consultants.

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