ACADEMIC GENERAL PRACTICE IN THE UK MEDICAL SCHOOLS 1948–2000; A SHORT HISTORY JOHN HOWIE AND MICHAEL WHITFIELD Edinburgh University Press, 2011 PB, 160, £19.99, 978-0784643561
The first university chair of General Practice in the UK was established in Edinburgh 15 years after the beginning of the NHS, in 1963. Academic general practice and primary care is now a strong and self-confident discipline, making major contributions to undergraduate education and to research in the UK medical schools and, of course, primary care is now at the heart of the NHS reforms, with self-evident implications for academic support
This readable compilation of accounts of how the discipline developed in each medical school, written by those most involved, at least in more recent events, may not have the brio of a David Lodge or even a CP Snow story but it is nonetheless an interesting one. Remarkable, really, to think of how those who had fallen off Lord Moran's ladder have emerged as research leaders, educational innovators, and Deans of medical schools. Many of the early units sprang from established departments of academic public health (and were often seen as almost identical to them by universities because they were ‘out there’, although nothing could be furtherfrom the truth). The general practice departments mirrored the mutidisciplinarity of general practice itself, so that collaboration between clinicians, allied health professionals, and social and behavioural scientists rapidly became commonplace. The GP departments were often the medical school leaders on the softer parts of the curriculum, such as medical ethics and communication skills.
The newer medical schools have recognised the value of a community focus, of teaching in general practices and the potential of primary care research, and set up primary care departments from scratch. Ironically, under pressures from institutional re-configurations and fashions in research structures and funding, some of the older departments are now becoming absorbed into relatively amorphous groups with halfhearted titles such as healthcare research and population sciences. The replacement of the generalist perspective by a focus on a single illness or organ may not be a particularly smart strategic move, particularly at this time of confusion, and therefore opportunity, in the NHS and in medical education and training.
The individual stories are tales of opportunities grasped and missed, heroes and villains, Davids and Goliaths. They are case histories which may not be general sable. The bigger story, and the messages for those interested in building up academic primary care, is touched on in the final appendix to the body of the text. The first essential building block was to convince the system of the ability of general practice to deliver high quality undergraduate education outside the walls of the medical schools, and then to prise the funding — SIFT in England, ACT in Scotland — out of the hospitals and into general practice to pay teachers properly and provide an adequate infrastructure. The next was to demonstrate the need for research in general practice by general practice, and to convince funders of its quality: the Medical Research Council Topic Review was crucial in this respect, and the Mant Report of NHS R&D was a further essential plank in the foundations, laying out the rationale for adequate funding for primary care research and the beginning of a career structure for primary care researchers. Getting senior academic GPs on to the same terms and conditions as academics in specialist medicine was another key to recruitment and retention.
Only 1:225 GPs has an academic post compared with 1:16 consultants — but this doesn't tell the whole story, because over half of all general practices in the UK are involved in undergraduate teaching and/or postgraduate training. Research activity, especially recruitment to trials, has been hugely enhanced by the creation of well-funded primary care and comprehensive research networks as part of the National Institute for Health Research (NIHR) Strategy, and the formation of the NIHR National School of Primary Care Research is the most recent endorsement of the value to the health service attached to primary care research. We have a good deal to thank our courageous and imaginative predecessors for, and this book is a fitting tribute to them.
The publication of this book is timely. As the focus of clinical work shifts further towards the community, the need for a highly skilled primary care workforce is greater than ever, and the medical schools have a key role in providing exposure and education in general practice for their undergraduates. As the complexities of illness and healthcare management increase, research that builds the evidence base for diagnosis, treatment and service delivery is crucial, and the university departments are once again in a pivotal role, for which they are uniquely well equipped.
- © British Journal of General Practice 2011
