How the GP Practice Can Stop a Global Health Crisis

Featuring contributions from Amanda Barnard (President, IPCRG) and Siân Williams (Chief Executive Officer, IPCRG)

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It often begins slowly.

The need to stop for a break halfway up a once familiar flight of stairs, or on the way to the shops; or a niggling cough that lingers weeks after a cold has passed; or the growing time it takes to get ready in the morning; or having to stop making plans for the week ahead…  

For hundreds of millions of people around the world, this is the experience of the slow, creeping onset of a chronic respiratory disease (CRD) – a leading yet long-overlooked cause of inequality, disability, and death. At some point, the journey almost invariably has the same destination: a primary care setting, a search for answers, and a fundamental question.

"What is wrong?"

If only answering it was easy.  What if the journey to an answer is hampered not by a lack of individual clinical expertise, but by a gap in healthcare strategies across the globe? By a reality where the front lines of care often lack the tools, education, and support needed to provide a swift and certain diagnosis?

This is the critical gap that the landmark United Nations General Assembly Political Declaration on NCDs is seeking to close urgently, with a clear argument:

The fight against CRDs is won or lost in the primary care settings that form the bedrock of health systems worldwide

Evidence behind an Unfolding Crisis

Behind every individual struggle lies a stark reality: despite being widely recognised as the foundation for prevention, early recognition, and long-term CRD management, primary care is often playing catch-up before it has even started.

Primary care professionals are on the frontline of healthcare, making choices that can change the trajectory of a person’s health, often without the resources that should be a given.

The core of the issue? Widespread lack of access to diagnostic testing including spirometry, leaving many without the certainty they need to suggest and initiate appropriate management plans and increasing the risk of under-, mis- and late diagnosis.

The diagnostic gap at the primary care level is starkly illustrated across the world. In Europe there are massive gaps in access to spirometry. In South America, primary care clinics often have no respiratory diagnostic equipment at all, including peak flow meters – a device to measure how fast you can exhale a lungful of air – that have been available since the 1990s in the UK for diagnosing asthma.

In a primary care setting, the impact of missing diagnosis is profound. The COPD Index Expansion Report highlights the scale of this challenge, referencing national data like Argentina's EPOC.AR study, which found that underdiagnosis of COPD reaches 77% of cases.

Similarly, a recent OECD report found a similar rate of 70% across its member countries. This means many patients do not receive a correct and timely diagnosis, severely limiting their chances for early intervention and adequate treatment.
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This diagnostic failure creates systemic inequity. The Severe Asthma Index 2025 found that a person’s health outcomes are affected less by their disease and more by the setup of their health system. For instance, the Index notes that a well-resourced country like Belgium can underperform in patient outcomes due to a fragmented system architecture and lack of a coherent strategic framework for primary care CRD detection.

This inequity often comes down to the varying roles of general practitioners (GPs). Because there is no single "right" way to structure a health system, workforce composition differs vastly by location; some countries rely heavily on GPs, while others depend more on respiratory specialists.

Location aside, the critical takeaway is that there must be sufficient primary care physicians and they must be equipped, authorised, and incentivised to make an effective diagnosis and work with the patient to agree on a personalised management plan for the long term.
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This is the reality that prompted the clear mandate for strengthening primary care in the UN Political Declaration on NCDs, where Member States committed to "scale up prevention, early diagnosis and treatment of asthma and chronic obstructive pulmonary disease" to meet the global target of reducing premature deaths from noncommunicable diseases by one-third by 2030.

Creating functional approaches, not fixed models

The global consensus is clear: the path forward requires a strategic pivot from fragmented, reactive care to an adaptable approach capable of providing consistently good care everywhere.

The forthcoming “From Policy to Practice” roadmap from the International Primary Care Respiratory Group (IPCRG) provides a blueprint for this change, understood through the lens of the World Health Organization’s (WHO) “5 Cs” approach – the essential principles defining quality primary care.

For this to be effective and decisive in identifying symptoms and providing an accurate diagnosis, it must be equipped with the right diagnostic skills and tools. But even then, this might not be enough.

In many countries, even when a primary care professional recognises the signs of a CRD, two bottlenecks may occur. Firstly, the system may require a referral to respiratory specialists for confirmation of the diagnosis, which can delay care unless there are very efficient diagnostic queues in place. Secondly, GPs may not be permitted to initiate treatment, which also creates a delay.

Empowering primary care physicians means giving them the tools and the authority to provide a timely diagnosis and initiate care. This can be achieved either by enabling them to do it directly – as they often do for conditions like diabetes, cardiovascular diseases, or anxiety and depression – or by providing a rapid diagnostic service that accelerates treatment.

Critically, this doesn't always mean the GP must perform the spirometry themselves. In parts of the Netherlands, for example, GPs refer to dedicated labs for testing, allowing them to focus on shared decision-making and long-term management once a diagnosis is confirmed.

The principle here is that the GP has the power to drive the process towards good patient outcomes, but in practice this also requires that step to be both easy and impactful.

Quality indicators influence clinical behaviour, and making the percentage of diagnoses achieved using an objective test for CRDs a core quality indicator would be a powerful step.

When this role is lacking, systems fail.

For the UN’s goal to become reality, an objective test like a spirometer must become as common as a stethoscope, paired with robust training for primary care clinicians to confidently make a diagnosis and immediately initiate care.

A key measure of success is whether primary care systems are in place to work with patients on the most common problems, which in CRDs include incorrect inhaler technique, smoking relapse, lack of physical activity, depression and anxiety.

Critical inhaler technique errors are made by up to 90% of patients, reducing the effectiveness of these therapies for asthma and COPD. The Severe Asthma 2025 data shows that Australia and the UK, for example, report high treatment access but also some of the highest hospitalisation rates – far exceeding countries with similar access such as Sweden and Canada. This paradox suggests that outcomes depend as much on how well primary care supports patients as on therapies. True support means continuity of care, offering routine, long-term management that accounts for an individual’s physical and mental health and domestic situation over time. This holistic approach is essential for helping patients with treatment and adherence, including inhaler technique, follow-up, and early intervention for flare-ups. Central to this is a trusted relationship between the clinician and the patient. However, recruitment, retention and time pressures are putting this continuity under threat.

Technology can support primary care, offering innovative solutions to achieve this continuity, not just through personal relationships but through health records. In Vietnam, for example, innovative electronic health records are overcoming a fragmented data landscape to enable longitudinal tracking and clinical decision support. Similarly, Estonia's national e-health system, in which every citizen has a single longitudinal record, has been shown to reduce hospital admissions as care shifted progressively to primary care.

Coordinating a patient’s care pathway by building bridges between primary and specialist care ensures expertise is available when needed. Conversely, systemic barriers, like outdated prescribing restrictions that force referrals and delay care, are a major obstacle.

Data on care pathways shows a clear link between investing in access to therapies and supporting care both in and outside of the hospital. For example, in COPD, systems with stronger public access to treatments are also significantly more likely to reimburse home-based care, ensuring continuity between hospital treatment and community-level management. Primary care and structured referral pathways also play a supporting role in sustaining this model.

Investing in Access + Care Beyond the Hospital
Countries with Stronger Access Also Build Broader Support Systems

From Global Commitment to Local Reality

So, what needs to happen now?

We need technical discussions at a national level to define how primary care can better address under- and misdiagnosis of CRDs and offer person-centred care consistently. It will require investment in electronic records, consistent staffing levels, and team education. It will also require difficult but necessary conversations about what primary care can stop doing.

Organisations like IPCRG have many examples of good primary care practice and practical improvement tools. But ultimately, it needs all stakeholders to decide to act by prioritising and developing a local system that works in their community, ensuring that a person’s ability to breathe and live well is not a lottery of geography or system design, but a universal right delivered with equity and excellence.