Don Berwick, emeritus president of the Institute of Healthcare Improvement in Boston, foresees a future, third era of medicine, driven not by professional dominance or managerialism, but by transparency, improvement science, less inspection and more civility.1 Steering general practice and primary care out of the current crisis into a new phase of professional confidence and clinical excellence — perhaps Berwick’s third era — will require attention, among other things, to recruitment, to career structures and retention, and to innovation and transformation. Clustered around Research articles exploring key aspects of determinants, perceptions, and decisions about general practice careers, are three important editorials which directly address these factors.
Professor Val Wass was asked by the health department to explore the present status of undergraduate medical student teaching in general practice and the ways in which students’ career aspirations are shaped by both the official and the ‘hidden’ curricula. Her report makes uncomfortable reading, and is an urgent call to action to medical school deans, academic departments of general practice, and GP educators to seriously up their game and focus on the promotion of general practice as a challenging and desirable career destination.2 We do not want to hear the phrase ‘I’m just a GP’, ever again.
It is a pleasure to publish an editorial entitled General Practice: The Heart of the NHS by Arvind Madan, Director of Primary Care at NHS England. He reiterates the statement made by the Chief Executive of the NHS, Simon Stevens, that ‘There is arguably no more important job in modern Britain than that of the family doctor’,3 and lays out a series of realistic proposals for the future, not ducking the serious problems that the profession currently faces. It is, of course, crucial that these ambitious proposals for transformation are supported by adequate financial resources, and recent reports on the progress being made with the Sustainability and Transformation Plans across the UK4,5 indicate that things are moving more slowly than many would like to see, and that complexities and tensions within the plans may be diluting the focus on strengthening general practice and primary care. In a recent BMJ editorial,6 Kieran Walshe called for direct government action to ensure timely implementation of these plans. Professor Tony Young is the National Clinical Lead for innovation for NHS England, and brings energy and vision to the task of designing an NHS fit for the future. Abraham Lincoln hit the nail on the head in 1862, when he said that ‘The dogmas of the quiet past are inadequate to the stormy present’, and Young’s editorial is an inspiring account of how things can and should change for the better in the near future. Going back to Don Berwick, his visits to NHS Vanguard sites in the UK on behalf of The Kings Fund have turned up some remarkable examples of brilliant new ideas in action in general practice and community health.7
As someone once said, the future is here, it’s just not evenly distributed.
- © British Journal of General Practice 2017