DOI: 10.12688/openreseurope.24209.1 ISSN: 2732-5121

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

Smith M, Al-Murani F, Sawyer M
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Background 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. Aim To explore the transferrability of KitNewCare principles to primary care and identify key lessons for sustainable, high-value general practice. Discussion 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. Conclusion 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.

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