Andrew Papanikitas is deputy editor of the BJGP, and a GP in Oxford. He is on Twitter/X: @gentlemedic
Readers may be forgiven for noticing, or indeed, failing to notice, the absence of celebratory articles in homage to the NHS in Life & Times, this special issue. And 75 years into the world’s most successful experiment in post-war solidarity, it feels inappropriate to throw parties for a service that is under siege, in a country that is divided against itself, in a world that is on fire.
This month’s articles highlight general practice at the heart of the NHS ecosystem, a powerful force for social good. It is clear that we shouldn’t waste too much time partying, and that not all of the work to be done lies within health care.
HOW ARE WE TO DEFINE GENERAL PRACTICE?
General practice is a specialty that is variously portrayed as besieged, or even dying in a toxic work environment.
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 notwithstanding, 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 21st-century life at our own peril.
Both [of the] books [reviewed in this issue], suggest that many of our mental health ills have an environmental component. No healthcare professional is themselves immune from the mental health pandemic.
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.
This article is also published in the BJGP, DOI: https://doi.org/10.3399/bjgp23X734781
- Hoban B. Hummingbirds and foxes. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734913.
- Machin A, Bennett J, Reeve J. Lazarus: working toegther to re-claim general practice. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734817.
- Rashid A. Sexual health in diabetes, contraceptive empowerment, legal support, and good Chinese doctors. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734841.
- Dawnay G. Seventy-five years of the NHS: but how many of our patients do we still keep sick? Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734793.
- Kemple T. Book review: How to Say Goodbye. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734889.
- Christmas R. The role of the GP in maximising school attendance. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734853.
- Hausmann E. Book review: What Mental Illness Really Is …(and What it Isn’t). Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734865.
- McKenzie-Edwards E. Book review: Stolen Focus: Why You Can’t Pay Attention. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734877.
- Papanikitas A. Book reviews: Three novels for planetary health. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/bjgp23X734901.