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For many years I was a disciple of the Starfield ­hypothesis—that­health­care­systems­with­a­stronger­ orientation­to­health­promotion,­disease­prevention,­and­ the­ provision­ of­ accessible,­ universal­ and­ integrated­ primary­care-based­services­led­by­generalist­physicians­will­achieve­better­health­outcomes­and­at­lower­ cost­ [1].­ Moreover,­ I­ have­ been­ persuaded­ by­ the­ chronic-care­ advocates­ that­ a­ seismic­ shift­ is­ occurring­in­the­burden­of­care­that­now­requires­a­systemic­ move­away­from­episodic­care­undertaken­in­specialist­ hospital­ institutions­ to­ long-term­ and­ integrated­ care­management­and­coordination­undertaken­in­the­ ­community­[2].­

Diagnostic delays and referral management schemes: how ‘integrated’ primary care might damage your health