75 years on and it’s business as unusual

HOW ARE WE TO DEFINE GENERAL PRACTICE?

Ben Hoban reflects on the changing roles and boundaries of general practice. Are we hummingbirds or foxes?¹ General practice is a specialty that is variously portrayed as besieged, or even dying in a toxic work environment. The solution, argue Machin, Bennett, and Reeve, is to give GPs the knowledge, support, and space to flourish as specialists in primary care.² This will, Lazarus-like, see general practice return from the dead. The question is whether our policymakers want this to happen.

VARIETY IS THE SPICE OF GENERAL PRACTICE

Variety is the spice of general practice, and Ahmed Rashid gives us a smorgasbord including sexual health in diabetes, contraceptive empowerment, legal support for homeless people, and a recipe for good Chinese doctors!³

GPs have long recognised that the relationship between health, illness, and health care is a complex one, and Giles Dawnay argues that, more than ever, we need to be mindful of the ways in which health care makes and keeps people sick.⁴

Terry Kemple reminds us that general practice provides care from the cradle to the grave with a review of a book about saying goodbye at the end of life.⁵

A PUBLIC HEALTH ROLE FOR GENERAL PRACTICE

Rowena Christmas argues that general practice has a public health duty to promote school attendance in children, and offers us practical ways in which to enact that duty.⁶ COVID-19 not withstanding, any British GP will recognise that for a long time now we have been living in a mental health pandemic, both in Britain and in other high-income countries. Elke Hausmann reviews a new book on mental health⁷ and Emma McKenzie-Edwards reviews Stolen Focus: Why You Can’t Pay Attention, by Johann Hari.⁸ Both books suggest that many of our mental health ills have an environmental component. No healthcare professional is themselves immune from the mental health pandemic and we ignore the warnings about the toxicity of 21^st-century life at our own peril.

The ultimate public health threat is existential in nature. Over the past year, we have maintained a planetary primary care column in BJGP Life. In this issue I review three excellent novels set in our near future that feel like Dickens’s three ghosts in their outlook on our prospects as a species.⁹ Climate catastrophe affects both the content and the nature of general practice both locally and globally.

So, these are interesting times. They call for an engaged and informed primary care community. This is a community that can both serve the health needs of patients and act as advocates and opinion leaders in both the NHS and wider society.

Let the politicians eat NHS birthday cake but let us all recognise that cake alone won’t save our beloved healthcare service.