In our work, we are defining primary and secondary care as follows:
Activity of a healthcare provider who acts as a first point of consultation for all patients. Generally, primary care practitioners are based in the community, as opposed to the hospital. Primary care practitioners refer cases they cannot manage or that require specialist attention to medical specialists in hospital or outpatient clinics for more complex or inpatient care. They can also refer patient to ancillary community social or medical services such as community midwives or nurses, social workers and so on. These can be called General Practitioners (GPs), Family Doctors or local doctors.
Hospital care (Secondary or Tertiary healthcare)
Hospitals usually provide inpatient and outpatient services delivered by medical specialists who generally do not have first contact with patients. Most hospital services are referred to as secondary care services and have more common specialised care based around major organ systems, such as cardiologists, urologists, orthopaedics, paediatrics, obstetrics and dermatologists.
A tertiary health centre provides more specialised consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a centre that has facilities for special investigation and treatment. Examples include: specialist cancer care, endocrinology, burns care and plastic surgery, or sub-specialities such as podiatry sub-speciality of orthopaedics and neurosurgery (brain surgery). Many tertiary centres also provide secondary care in addition for their immediate catchment area population.
Where primary care is still developing or there is no integration between primary and specialist care services, such as many LMIC, patients may self-refer to secondary or tertiary care providers for most healthcare needs thus using them as primary care providers. This makes for a highly inefficient and expensive healthcare system with demotivated clinical staff who are either underworked and under-stimulated at the primary level or over-worked and frustrated at the secondary and tertiary care level.