Many common pressures are experienced by health care systems in the developed world. Economic pressures associated with the proportion of GDP spent on health care are foremost for governments; in the UK, total health care expenditure as a percentage of GDP was 6.2% in 1997, rising to 8.1% by 2007 and 8.8% by 2013 (ONS, 2013). Growth in health care spending has dwindled in the UK over the last three years due to rationing and budgetary cutbacks, despite upwards spending pressure associated with technological advances and demographic factors (OECD, 2016). Virtually all developed countries face increased health care demand from a rising proportion of older people and from individuals living longer with chronic conditions, e.g. diabetes. These forces combine to exert pressures on health care to maintain, improve and in some cases transform systems for the delivery of care. Some of these pressures are also experienced by medium- and low-income countries, alongside additional demands related to shortages of skilled clinical staff and geographic characteristics.