How to be a Good Enough GP: Surviving and Thriving in the New Primary Care Organisations

How to be a Good Enough GP: Surviving and Thriving in the New Primary Care Organisations by Gerhard Wilke with Simon Freeman. Radcliffe Medical Press, £19.95, pp 224. ISBN 1 85775 358 5. Rating: ★★★

One day GPs will no longer be surprised or thrown off track by political change. One day we will come to embrace change with the same guarded conviction we show when we learn about new drugs. We may pause and resist, but rather than oppose we shall come to listen, learn, digest, and finally accept.

Accepting change without experiencing permanent grief will require a cultural shift—one that will only come, Gerhard Wilke argues, with the end of the overidealised doctor-patient relationship. Wilke's highly accessible discussion about change comes charged with the wearisome wisdom of one who has observed at first hand the chronic bereavement that GPs have been struggling with since the 1990 “New Contract.”

Since then, of course, there has been fundholding, there have been primary care groups, and now we are involved in setting up primary care trusts.

Recent history, therefore, suggests that change is inevitable, leaving little room for nostalgia. Wilke advises us that if we are to survive in general practice we must relinquish any yearning for the lost world of an NHS that is free of politics and resource management. We must also be aggressive enough to formulate our own needs and negotiate for them. Survival and recreation in the current context of continuous change and improvement, says Wilke, depend on whether the doctor can learn that self care is the best way to improve patient care.

But as with the gestation of all publications, even Wilke's book has not kept up with the pace of change. It was conceived at the time when primary care groups were just beginning to emerge, but most of us have already moved on.

Despite this, How to be a Good Enough GP is a useful and thought provoking read for anyone interested in relationships and organisations. Cut to the section on Wilke's observations of the dynamics rife in a single practice, and it becomes abundantly clear that what does—or does not—work for a small group has much relevance for larger organisations. The same conscious and unconscious processes apply. If you are now actively involved in primary care trusts, look at what happens in your own practice, and take note.