In February 2020, a man with a cough walked into a general practice in London, UK, and asked to see a doctor. Three days later, the receptionist felt unwell; within a week she was dead. As the horror of the pandemic unfolded, primary care services around the world quickly adapted to respond to demand and ease the pressures on secondary care. Access and consultations became remote by default, creating new opportunities for technology-supported care but fracturing the intimacy of the traditional clinical relationship. With inadequate respiratory protection, people caught covid-19 at work and passed it on to their families. The full toll of lives and healthy life-years lost will never be known. Traumatised and burnt-out staff retired early or left the sector; those who remain struggle with rising workload.

In short, primary care is suffering. At an individual level, suffering occurs when a core aspect of someone’s identity or existence is threatened. It results particularly when we cannot control actions that define our view of ourself. It is characterised by loss—of function, of autonomy, of valued relationships and of sense of self. As we all know, the suffering patient requires witness and compassion.

Applying these principles to the primary care sector, and drawing on insights from the philosophy and clinical management of suffering, I will ask three questions.
- First, which core values of primary care are at stake as a result of the pandemic? How has our identity as a sector changed, and what has been lost in the shift?
- Second, to what extent and in what ways has the primary care sector lost control of the activities and practices which used to define it?
- Third, who is listening to primary care’s story—and how can we invoke the compassion on which the sector’s recovery depends?