What primary care can learn from KitNewCare: A framework for sustainable healthcare

KitNewCare (KNC) is a multi-centre European initiative to improve the sustainability of kidney care while enhancing quality, prevention, and system efficiency. Although developed within nephrology, its principles are relevant to primary care, where most long-term condition management, prescribing, and diagnostic decision-making occur.

To explore the transferrability of KitNewCare principles to primary care and identify key lessons for sustainable, high-value general practice.

KitNewCare proposes a systems approach to healthcare redesign structured around four pillars: prevention, supported self-care, leaner pathways, and clinician leadership. Prevention aligns closely with primary care’s role in mitigating chronic disease progression, while also reducing downstream environmental and system burden. Supported self-care highlights the importance of avoiding overmedicalisation, focusing intensive intervention on those at highest risk while enabling safe reduction of monitoring and intervention in low-risk populations.

The concept of leaner pathways is particularly applicable to general practice, where investigation cascades, monitoring, and defensive referrals generate significant downstream workload and potential harm. KitNewCare emphasises reducing low-value steps, strengthening uncertainty tolerance, and supporting more deliberate approaches to testing and referral decisions. Clinical leadership is positioned as central to system change, with clinicians acting as both designers and communicators of more sustainable care pathways.

A key innovation within KitNewCare is its four-factor impact framework, which evaluates outcomes across health, financial, environmental, and social domains simultaneously. This is complemented by developing benchmarking tools that integrate sustainability metrics into routine clinical decision-making. The programme also emphasises at-scale learning, shared implementation, and embedding sustainability within existing quality improvement processes rather than as an additional burden.

KitNewCare offers a transferrable framework for primary care transformation. Its central insight is that sustainability is not separate from clinical quality but embedded within it, emerging from better decisions about when to intervene, when to observe, and how to reduce avoidable harm across the system.

KitNewCare is a European programme that aims to make healthcare more sustainable while improving patient outcomes and making better use of resources. Although it was developed within kidney care, many of its principles are relevant to primary care, where most long-term conditions are managed and where decisions about prescribing, testing, monitoring, and referral are made every day.

This article explores how the KitNewCare approach could be applied in general practice. The programme is based on four key ideas: preventing illness before it becomes more serious, supporting people to manage their own health where appropriate, reducing unnecessary steps in care pathways, and empowering clinicians to lead change.

Many of these principles align closely with the challenges facing primary care today. Avoiding low-value tests, appointments, referrals, and treatments can reduce workload, costs, and environmental impact while improving patient experience and outcomes. KitNewCare also encourages healthcare systems to consider health, financial, environmental, and social outcomes together when making decisions and evaluating success.

The central message is that sustainability should not be seen as an additional task for primary care. Instead, it can be achieved through high-quality, patient-centred care that focuses on prevention, reduces unnecessary intervention, makes better use of resources, and minimises avoidable harm across the healthcare system.