Words and Meanings

TS Eliot asks ‘where is the knowledge we have lost in information?’,¹ perhaps a little disingenuously for someone for whom the precision of linguistic expression was so important. Good communication — the clear and unambiguous transmission of information by speech, writing, and other media, or by non-verbal means — is central to most human activities, not least the organisation and provision of health care. Clarity of expression, however, can hardly be regarded as a feature of much that has been written over recent years on health policy and, in particular, the politics of the NHS. Policy papers are frequently littered with this year’s jargon: remember ‘world-class commissioning’ and ‘the race to the bottom’(!). Medicine has a strange language all of its own and potentially important catchphrases like ‘integrated care’ and ‘translational research’ are batted to and forth, with different meanings for different audiences. This issue of the BJGP has a focus on communication and includes some important studies on verbal and non-verbal doctor–patient communication, the provision of information to patients and parents, associated issues of health literacy and medical record keeping, and the documentation of sensitive patient information.

We also discuss three crucial aspects of health policy and the problems facing general practice and primary care in the UK: alternative funding models for the NHS, the future of the independent contractor status of GPs, and the huge challenge of making general practice a more attractive career option for medical students and new graduates. The arguments for and against co-payment are set out by Professors Les Toop, from the University of Otago, New Zealand, and Claire Jackson, University of Queensland, Australia, from whom we have much to learn about this topic. Although this discussion was never on the table before the general election, it is almost bound to surface in the years ahead as, unsurprisingly, the efficiency savings on which full public funding of the NHS depend do not materialise and costs rise faster than predicted. We asked five commentators to discuss the pros and cons of retaining or giving up the independent contractor status of GPs, and the finely-balanced arguments suggest that a mixed economy may, at least in the short term, be preferable, although it’s hard not to look forward to a time when GPs have a proper career structure.

The paper by Alex Harding and colleagues, on behalf of the Heads of Teaching Group of the Society for Academic Primary Care is disquieting, because it suggests that the drive to increase the amount of general practice and community-based teaching in the undergraduate curriculum, urged by the General Medical Council and widely endorsed in curriculum statements, is running out of steam and that funding to support it is flagging. This reduced exposure to general practice, particularly if that exposure is sometimes to demoralised GPs contemplating early retirement, is not exactly a recipe for the recruitment of the several thousand new GPs promised by politicians.

A further editorial deals with a topic of increasing national and international concern, that of female genital mutilation (FGM). This ghastly practice needs to be firmly eradicated worldwide. A World Health Organization statement on ending the practice was published in 2008, but doing so is far from straightforward. An ill-judged prosecution, coming to court in London recently, failed, although it probably served to raise awareness of FGM. The new amendments to the Serious Crimes Act mandate reporting by healthcare professionals of confirmed FGM to the statutory services, but this in itself raises a number of potential difficulties for clinicians working in many settings, spelt out in the important contribution by Nigel Mathers and Janice Rymer.

Distractions in Out of Hours this month include a review of the ancient Greek art exhibition at the British Museum, snapshots of primary care in Armenia and South Africa, some reflections on the Welsh poet and doctor, Dannie Abse, and a number of personal views on aspects of our profession for you to enjoy, applaud, or take issue with. Please let us have your comments through the eLetters facility on our website.

• © British Journal of General Practice 2015