DEBATE Organisation of services fo in r

Full list of author information is available at the end of the articleBackground In many countries, increasing demand for the provision of high quality health care services combined with con-straints on health care funding are driving health care systems to seek suitable alternatives to high cost special-ist care. Health care systems with better developed pri-mary care tend to have lower health care costs [1], and stronger primary health care is associated with lower all-cause mortality, as well as cause-specific premature mortality, including cardiovascular diseases [2,3]. In economically developed countries, cardiovascular disorders account for substantial proportions of health care expenditure [4-6]. Higher costs for secondary care services in comparison with the management of prob-lems in primary care [3], difficulties in accessing special-ist services, including long waiting times for specialist consultations [7], fragmented care due to lack of com-munication across the health care system [8] as well as a small number of conditions that do not have clearl