Books: The Exceptional Potential of General Practice: Making a Difference in Primary Care

In the introduction to his new book, Graham Watt likens its contents to a ‘tapas menu’, best sampled in different selections rather than as a series. In serving up this menu, Watt has provided something light and refreshing but not without sustenance. The book itself serves to keep the torch of general practice burning bright and strong.

Rather than provide another overarching academic critique of the value of general practice (community-based primary medical care), Watt provides us with a more illuminating constellation of contributions from GPs at the frontline, academics, and other health professionals who are seeking, through a variety of methods, to realise the exceptional potential that high-quality general practice can provide for those who it serves. The book’s opening chapters summarise some of the challenges (for example, multimorbidity, mental health, and social exclusion) that the literature describes in developing general practice services, particularly for socioeconomically deprived communities. The following chapters provide some shining examples of responses to these challenges.

Watt’s telescope naturally focuses mainly on some ‘stars’ from his home country of Scotland, but includes others from across the world that vary from integrated health and social care projects based in general practice (the Govan Ship Project, Scotland), training programmes reaching out to excluded groups (Dublin, Ireland), examples of individual projects setting up GP practices embedded in their communities (Belgium, Ireland, Australia), and particular centres of innovation (Tower Hamlets, England).

Throughout this constellation three large bodies of work are moving that provide the gravity to hold the book together and the explanation to how the potential might be realised. The first is the pioneering work of Julian Tudor Hart, with whom Watt worked and to whom the book is dedicated. Tudor Hart was not only decades ahead of his time in the way he developed community-based clinical practice in the village of Glyncorrwg in the 1970s, but also in his essays and vision on the potential of the NHS itself as a national institution, and how both undergraduate and postgraduate education and training might be helped to recognise this. The second is the work of Barbara Starfield, and in particular her four Cs — ‘Contact (accessibility through community base), Continuity, Comprehensiveness, and Coordination’. The third is the growing Deep End General Practice movement, of which Watt was a founder member, and which is now an international network of GPs and their colleagues striving to make a difference by supporting and advocating for high-quality general practice for those communities that need it most. There is no apology for focusing on these communities, recognising Tudor Hart’s ‘inverse care law’ and highlighting the health inequities such communities face because of political decisions about funding made elsewhere.

The book appropriately draws to its close with a chapter on education and training as it provides a useful introduction for anyone unfamiliar with this body of work. For those already engaged in similar work in whatever form, it provides a useful summary of the founding principles that underpin their efforts, some examples of work elsewhere, and a reminder that they are very much part of a whole.

• © British Journal of General Practice 2020