edication review, patient education, patient empowerment and caring for vulnerable populations are among the roles and responsibilities of family physicians, also called general practitioners or primary care physicians. Family Physicians are closely linked to families in the community and have long-term relationships with them. They provide holistic care to their patients. This cadre can be utilised in the provision of basic care to terminally ill patients in the community as well. Such integration would ensure smooth communication and care for their critically ill patients, particularly in low- and middle-income settings where access to specialist care is limited. To achieve this, primary care physicians’ integration into the national health system and appropriate training are mandatory. Primary care physicians can seek guidance from specialists for complex cases. Most palliative care patients prefer to be in their home environment, close to their loved ones. Seamless, patient-centred care can be achieved through primary care. In the current healthcare system, such a collaboration does not exist; however, measures can be taken to promote such an initiative.

Family physicians’ responsibilities span from patient education and disease prevention to managing acute and chronic conditions. Improved women’s health, reduced infant and maternal mortality and better contraception counselling with reduction of unintended pregnancies are some of the outcomes observed in regions with established primary care systems. There is strong evidence that improving access to healthcare services through integrating family planning into primary care and implementing focused interventions that address key barriers and myths around contraception use alleviates challenges related to contraception access and use.

Protecting patients’ rights and acting in their best interest is a fundamental part of family physicians’ functions. However, challenges persist in many settings. These include shortages of essential medications and inadequate supplies at basic health facilities. These systemic issues must be addressed to enable family physicians to fulfil their advocacy role effectively.

Lifestyle medicine is part of everyday primary care or general practice consultations. However, limited access to well-established primary care services has led to no clear distinction between lifestyle medicine and alternative medicine in the public’s understanding. Patients can be misguided as a result. Family physicians are well-positioned to connect with their communities. This “gatekeeper” workforce must be well-resourced regarding both human and planetary health. Air pollution, extreme heat and loss of green spaces directly impact respiratory, cardiovascular and mental health—conditions that family physicians see daily. This positions primary care providers as key advocates for environmental protection alongside individual well-being.

The rising burden of non-communicable diseases presents a compelling case for strengthening primary care. Diabetes, hypertension and cardiovascular disease now account for a significant proportion of morbidity and mortality in Pakistan. These conditions require continuous management, patient education and lifestyle modification—all of which are best delivered through primary care. Family physicians, with their longitudinal relationships with patients, are ideally positioned to provide early detection, ongoing monitoring and coordinated care for NCDs, reducing the burden on tertiary hospitals and improving long-term outcomes.

The key to transformation is a structured, well-organised primary care system with trained family physicians across the country.

These aspirations cannot be realised without addressing the severe health workforce shortage. Pakistan faces a critical deficit of trained family physicians, compounded by brain drain and an uneven distribution of healthcare workers between urban and rural areas. Many basic health units remain understaffed or staffed by personnel without adequate training in comprehensive primary care. Investing in medical education, creating attractive career pathways for family medicine and implementing retention strategies for rural postings are essential steps toward building a sustainable primary care workforce.

The question of financing is equally important. Pakistan’s health expenditure remains among the lowest in the region and out-of-pocket spending continues to push families into poverty. The Sehat Sahulat Programme has expanded insurance coverage, but its focus on hospital-based care does little to strengthen primary care. For universal health coverage to become a reality, there must be a deliberate shift in financing toward primary care services, ensuring that family physicians are integrated into the national health system and adequately remunerated for their preventive and promotive roles.

What is the way forward? The key to transformation is a structured, well-organised primary care system with trained family physicians across the country. Are practicing family physicians equipped to meet individual patient needs? The patient education deficit can only be addressed through strengthening primary care. The focus must be on training in patient-centred consultations in primary care rather than superficial symptom-based treatments which lack an evidence base. Once generalists are upskilled, palliative care, particularly for non-malignant conditions, can be shifted to primary care. Keeping in view the growing need for such services, it is worth investing in a trained and skilled primary care workforce through training and mentoring schemes and ensuring these services are sustainable long term. For better population health, a well-equipped primary care workforce is essential. This will reduce the current excessive workload on secondary care and unnecessary hospital admissions. Robust primary care is cost-effective and improves quality of care and patient outcomes.

Dr Hina Jawaid is an associate professor in family medicine at Health Services Academy, Islamabad.

Dr Tehzeeb Zulfiqar is a research fellow at the Australian National University, Canberra.The key to transformation is a structured, well-organised primary care system with trained family physicians across the country.