The seven Shared Principles are listed in Table 1. The collaborative process reidentified the four classic Starfield principles—continuous, comprehensive, coordinated, and accessible—along with several other important concepts. The complete text of the Shared Principles is included verbatim in Appendix 1 (https://journals.stfm.org/media/2045/epperly-appendix1.pdf); the list of endorsing organizations is online at https://www.pcpcc.org/principles/signers. Following are some of the most salient modifications and how they are different from other sets of primary care principles.

The decision to replace “patient centered” with the term “person and family centered” was a very intentional one, responsive to concerns expressed by consumer advocates that the word “patient” objectified individuals in a sick or dependent role. The principles sought to move beyond the narrow framework of a disease care system to one promoting health. This first of the Shared Principles affirms an empowered partnership role for individuals and families. For example, the principle asserts that:

primary care is grounded in mutually beneficial partnerships among clinicians, staff, individuals, and their families, as equal members of the care team. Care delivery is customized based on individual and family strengths, preferences, values, goals, and experiences using strategies such as care planning and shared decision making. There are opportunities for individuals and their families to shape the design, operation, and evaluation of care delivery.

This principle reiterates the longstanding precept that dynamic, trusted, respectful, and enduring relationships between individuals, families, and their clinical team members are hallmarks of primary care.

The secret sauce of primary care is the ongoing trusting relationship between clinicians and the primary care team and individuals and families that is a healing process unto itself. This allows the importance of a sustained incremental approach over time to be foundational to dealing with acute, chronic, behavioral, and prevention-based health care problems and issues.18

This principle emphasizes important contemporary aspects of comprehensive primary care, such as behavioral and mental health as well as oral health. Primary care serves all ages, both genders, and the majority of health care problems. The principle also ties comprehensiveness to emerging concepts in health equity, calling on primary care to:

seek out the impact of social determinants of health and societal inequities. The more comprehensive the skill set and scope of practice is in the existing clinic setting the higher the percentage of problems that can be cared for in the primary care setting. Primary care practices are also recognizing the importance of the social determinants of health and linking patients who have social determinate issues (eg, food insecurity, transportation issues) with community resources that can further work with them to resolve these issues. Primary care practices partner with health and community-based organizations to promote population health and health equity, including making inequities visible and identifying avenues for solution.

Current research demonstrates that health care influences only approximately 10%-20% of a person’s health, with a person’s behaviors, environment, genetic makeup, and social conditions being the most powerful determinants of health, illness, and death.19

This principle affirms that individuals and families are critical members of primary care teams. In recognizing the multidisciplinary nature of team-based care, it also asserts that health care professional members of the team are trained to work together at the top of their skill set, according to clearly defined roles and responsibilities.

This principle broadens the importance of relationships to include the entire primary care team. Many team members, from nurses, medical assistants, receptionists, social workers, nutritionists, and clinicians, form relationships with the persons and families cared for by the practice. All primary health care team members are important in the delivery of team-based collaborative care. This distribution of workload across the team is fundamental to decreasing clinician and health care team member burnout and increasing the joy in practice.

The Shared Principles largely reiterate the central emphasis on contemporary issues such as “transitions of care to achieve better health and seamless care delivery across the life span.” The term “integrated” refers to how the individual’s health data and records can inform care within the primary care team and with other health care professionals in the medical neighborhood. The term “coordinated” refers to how health care is seamlessly arranged with others participating with the individual’s care outside of the primary care practice in the medical neighborhood. With the emergence of evolving health information technology, new and dynamic ways of integrating and coordinating health care information and data can be performed both synchronously and asynchronously with individuals to optimize their health care and health.

This principle acknowledges the changing nature of access in a digital communication era, asserting that:

primary care is readily accessible, both in person and virtually for all individuals regardless of linguistic, literacy, socioeconomic, cognitive, or physical barriers. This accessibility goes far beyond the concept of face-to-face visits. Meeting patients’ health and health care needs electronically, telephonically, and in other technologically empowered ways is both achieving person- and family-centered care and high-value accessible care. Primary care provides individuals with easy, routine access to their health information.

Moreover, person- and family-centered access means that “clinicians and staff are available and responsive when, where, and how individuals and families need them.”

This principle goes further than most prior formulations by asserting that primary care has responsibility for both quality and patient experience cost components of health care value, and once again highlights the importance of a person- and family-centered approach.

Primary care achieves excellent, equitable outcomes for individuals and families, including using health care resources wisely and considering costs to patients, payers, and the system. Primary care practices employ a systematic approach to measuring, reporting, and improving population health, quality, safety, and health equity, including partnering with individuals, families, and community groups.

Additionally, one cannot place enough value on the importance of the trusting relationship to drive quality and patient safety and to appropriately lower health care costs.

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Conclusion

The United States health care system is at a critical crossroad in its transformation. The foundational importance of primary care in our future health care system cannot be overstated. The undertaking of the collaborative process of refocusing on the value of primary care by diverse stakeholders forming new partnerships both inside and outside of health care is fundamental to this effort. This shared process of principles creation across multiple stakeholders helps create a bonding covenant with our patients and the public.

This set of seven Shared Principles of Primary Care helps define the foundational importance of what primary care does to advance better health, a more satisfying health care experience, and more affordable costs. The Shared Principles were formulated with an understanding that they are aspirational. For them to be actualized consistently and robustly across the diverse landscape of primary care practices in the United States will require not just commitment from the primary care practice community, but also a willingness of the public, payers, and policy makers to prioritize primary care. With more than 300 organizational endorsers, the Shared Principles provide an opportunity for individuals and organizations committed to a vibrant primary care sector to speak with one voice about the bedrock elements of primary care and their importance to the health system. Although the specific ways of delivering primary care will continue to evolve as our complex health system changes, these core principles help to define the enduring essence and value of primary care.

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