Irvine Loudon, John Horder
Oxford University Press, £45, pp 329
ISBN 0 198206 755
The path travelled by general practice since 1948 is dotted with milestones: the foundation of the (Royal) College of General Practitioners (1952), the creation of the first Chair of General Practice in Edinburgh (1963), the Family Doctors’ Charter (1966), mandatory vocational training (1975), etc. Along the way, the service has been almost totally transformed. The professionally isolated, single handed general practitioner of the early years has evolved into the multipartner practice. The inadequate premises, facilities, and support staff that Collings described in 1950 have given way to the purpose built health centre and the multidisciplinary primary care team. Other indications of the increasing maturity of general practice as a clinical discipline are also evident. In both teaching and research it has asserted its right to equal status with hospital based specialties. Finally, after 50 years of waiting in the wings, the ugly duckling of national health policy has taken centre stage.
These are just some of the events and themes that are recalled and analysed in this book. It is the third volume in a series that tells the story of general practice from 1750 to the present. It is destined (rightly) to become a standard reference for the history of general practice in the NHS, and it should be read by anyone wishing to understand how general practice has become what it is. The list of contributors reads like a Who’s Who of 50 years of general practice research; their lives are often intimately bound up with the developments that they recount. This intertwining of autobiography and history not only mirrors one of the core features of general practice itself but also adds immeasurably to the pleasure of reading these accounts.
The book also faithfully reflects two other characteristics of contemporary general practice—its ambivalence towards the concept of primary care and its suspicion of closer incorporation into the NHS. The relation between general practice and primary care is largely unexplored; indeed, the two terms are generally treated as interchangeable. Bevan once described the NHS as “a great collective experiment ... through the agency of a profession which abounds in individualism.” Undoubtedly he was referring to the medical profession generally, but he might have had general practitioners and their wish to retain their independent contractor status specifically in mind. They now face a further round of collectivisation in the shape of primary care groups. It will be fascinating to observe how these reluctant collectivists of the NHS fare over the next half century.
Footnotes
Rating: ★★★★