Methven Forbes, CEO of Fuller & Forbes Healthcare Group on the importance of primary care in healthcare systems
Few people bridge the gap between community-based medicine and international health system reform like Methven Forbes, co-founder and CEO of Fuller & Forbes Healthcare Group in the UK. A former NHS partner turned global consultant, he heads up one of the UK’s most innovative primary care networks — a group of practices serving more than 100,000 patients through multidisciplinary teams, digital-first access, and comprehensive community engagement.
Methven has spent years designing primary care at scale. At Fuller & Forbes, he leads multidisciplinary teams and has helped oversee the development of in-house high-volume e-consultation services, as well as the integration of clinics within their communities. “Primary care has to be the community’s first port of call and the filter for conditions that need hospital care,” he says. “In the Middle East, this structure means clear triage at the front door and pathways that stop hospitals becoming the first port of call for routine issues.”
The value of primary care systems
Alongside a multidisciplinary approach to family practice, he emphasises the need for meaningful scale in primary care — particularly in large urban settings. “Take a city like Leeds, with 800,000 residents and five hospitals. It’s simply not feasible for every person to walk through those hospital doors with every health concern. Primary care acts as a triage point — diagnosing and treating where possible and referring when necessary. Without that filter, hospitals would quickly become overwhelmed,” he explains.
But he’s equally clear that a proliferation of small, disconnected clinics isn’t the answer either. “What’s needed is fewer, stronger primary care hubs, rooted in their communities but large enough to operate at scale across a defined geography. That’s what allows you to extend hours, share diagnostics, build digital teams and invest in training. It’s the difference between simply aggregating clinics and designing an integrated health system. Only with that kind of scale can we make population health and prevention a reality.”
In his view, an integrated model could be particularly valuable in the Gulf. “With notable exceptions such as Kaiser Permanente, we’ve seen that in the US, scale without integration doesn’t change outcomes. But we must define what we mean by integration: staffing, pathways, processes, IT infrastructure, funding, for example. In the Middle East, governments have a rare opportunity to build integrated primary care from the outset — primary care that grows in step with population, data, and demand.”
Clear definitions are essential because they underpin the design of health systems. “Primary care, as a term, can refer to anything from a minor illness clinic at one end of the scale to a comprehensive medical centre offering everything short of in-patient care. So how should we define it? In my view, primary care is the principal interface between a patient’s non-accident, non-emergency need and the infrastructure that responds to it.”
For Methven, primary care can provide direct treatment or intervention, either at the first appointment or via internal referral and, where necessary, guide patients towards hospital or specialist diagnostics when care cannot be delivered in a community setting. “At its core, primary care should be the community’s first point of contact for both urgent and ongoing needs — the gatekeeper that filters genuine secondary or tertiary care,” he says.
He adds that incentives, culture, and access all influence how people engage with healthcare. “In insurance-led markets, people often equate value with seeing a specialist quickly. To shift that mindset, you need easy digital access, reliable triage, and consistent quality, so that choosing primary care feels like an upgrade, not a compromise.”
He points to the UK as a case study in how system design can influence patient behaviour and how primary care can evolve over time. “The UK has a long history of delivering primary care at scale, dating back to the post-war creation of the NHS. What began as a doctor-led service working from home has progressively developed into multidisciplinary medical centres, bringing together GPs, nurses, pharmacists, physiotherapists and other allied health professionals, all focused on delivering care that adds real value.”
Like many healthcare systems globally, the UK’s model has come under strain in the wake of COVID-19. But rather than seeing this as a failure, he views it as a signal: the system is ready for its next phase of evolution. “Populations grow, age and change. Technology advances. Care models must adapt in response,” he says.
When UK primary care began offering improved access and a broader mix of clinicians and services — chronic disease management, minor surgery, ultrasound, specialist medicines management — this change enabled hospitals to focus more on the higher end of their competencies, a shift made possible by thoughtful system design. “The same principle holds true elsewhere, whether in Riyadh, UAE or beyond, but success depends on tailoring the model to local cultures, regulations and funding systems.”
The importance of digital health
Fuller & Forbes Healthcare Group delivers more than 100,000 e-consultations a year made possible through the development of their own proprietary digital solutions. For Methven, digital tools have become an essential component of healthcare system design. “They should be used where they add value. Done correctly, they are safe and efficient, and patients love the fact they can complete 24/7 and will have a response during the next working day.”
He sees promise in the UAE’s digital health landscape, particularly Abu Dhabi’s Sahatna app that integrates with the Malaffi health information exchange platform. “Sahatna gives patients access to records, appointments, teleconsultations, even genomic reports,” he says. “It’s exactly what clinicians need: a single, timely view of history, medication, labs and imaging.”
While the UK is still wrestling with non-interoperable systems, Methven sees huge advantage in the UAE’s proactive design. “Abu Dhabi is pushing a unified layer early, and that’s smart,” he says. “The next step is making sure every primary care provider works inside that ecosystem every day.”
Safeguarding the future
If the UAE can connect Abu Dhabi’s Malaffi, Dubai’s Nabidh (the health information exchange platform) and the federal Riayati (the National Unified Medical Record or NUMR platform) into a seamless national network, Methven feels the benefits will be immense. “In the future, there is the potential for remote monitoring and data integration,” he adds. “Imagine chronic disease management where blood pressure readings from home flow straight into a medical record. That’s a game-changer. Then layer on e-consultations, video consultations, data collected from health rings and watches.”
And the possibilities are endless if there are also escalation rules and clear medico-legal coverage. “High-resolution video, connected stethoscopes, home vitals, ambient sensing can all safely handle a big slice of routine care with such safeguards in place. The technology isn’t the hard part — it’s the governance protecting both patients and clinicians.”
In his view, therefore, regulation must also evolve. “Clinical quality and premises safety are completely different competencies,” he says. “Clinical quality (prescribing, referrals, clinical pathways, and adherence to evidence-based care) belongs with professional regulators supported by data. Premises and operations, such as safety, accessibility, information governance, should be licensed like facilities. The Gulf would do well to set standards for sites and separately hold clinicians to evidence-based practice. That’s how you protect both patients and staff.”
Along with many other experts, Methven can see the potential in designing a primary care system that integrates seamlessly with the complete health and social care ecosystem. “The region has the chance to leapfrog. Most countries are retrofitting digital and integrated care into legacy systems. The Gulf can design it right the first time: multidisciplinary, connected and patient-led. Primary care is the front door to any sustainable health system. Design it well and everything else falls into place. Design it badly, and you spend the next twenty years trying to fix it.”
CONTACT INFORMATION
methven.forbes@nhs.net