Primary Health Care Research & Development


Building on Julian Tudor Hart’s example of anticipatory care

Graham Watta1 c1, Catherine O’Donnella2 and Sanjeev Sridharana3a4

a1 Professor of General Practice, General Practice and Primary Care, Division of Community-Based Sciences, University of Glasgow, Glasgow, UK

a2 Professor of Primary Care Research and Development, Division of Community-Based Sciences, University of Glasgow, Glasgow, UK

a3 Director, Evaluation, The Centre for Research in Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada

a4 Associate Professor, Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada


The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and long-term relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome.

(Received February 25 2010)

(Accepted May 30 2010)

(Online publication August 12 2010)


c1 Correspondence to: Professor Graham Watt, General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow G11 5AW, UK. Email: