Now we need a framework for action

Over the past decade, there has been growing policy interest in the role of primary care within the Canadian health system, with the recognition that it has not been fully integrated and that its full potential has not been developed. The framework of Kates et al. starts to address some key organizational issues, by placing the patient, family and community at the centre of the healthcare system and by combining the Institute for Healthcare Improvement's Triple Aim approach with the Institute of Medicine's six improvement aims. What this framework does not do is provide a model of how to organize or deliver primary care or demonstrate how policy makers and those responsible for designing the healthcare system should structure organizational models, payment systems or accountability structures. Kates et al. have provided a useful first step. We now require a commitment to act.