Terry Kemple is a retired GP living in Bristol. He has various roles promoting greater sustainability in general practice. He is a past President of the Royal College of General Practitioners. He is on X: @TKemple
General Practice is changing. It changed dramatically in the last 50 years, but where is it going now and who is shaping it? Professor Sir Denis Pereira Gray (1935- ) was an eyewitness to the changes and shaped many of them with his vision for the discipline of general practice. The essence of a discipline is having a research-based body of knowledge that can be taught. He has been described as ‘…one of the prophets’ in general practice, and ‘…the patients champion.’
He grew up in Exeter learning his love and the value of good general practice from his father and grandfather in their family business – General Practice. At Cambridge he played and studied chess more than medicine. He believes ‘chess is good training in trying to foresee the best possible move by a competitor or opponent.’ As he progressed from clinical student to junior doctor and new GP, he discovers that his hospital-based teachers, seniors and colleagues constantly belittle General Practice. If GPs deserved any consideration, it was only as the lowly servants at the high table of hospital medicine.
He believes ‘chess is good training in trying to foresee the best possible move by a competitor or opponent.’
His career and the chapters read like a series of chess games. His hospital-based colleagues’ mindset is that GPs are the lowest value piece on the chessboard of medical careers – ‘just a GP’. His career starts in his father’s general practice then by using his deepening knowledge of his chosen discipline, increasing political skills, understanding of people and his attitude that general practice is a distinct discipline that merits parity of esteem with any other medical speciality he advances by capturing or checking opponents. His reputation grows in the Southwest and with a mix of persistence, persuasion and politics he extends his influence across the national leadership of medicine. There are many pithy one-liners to enjoy, such as the observation that the RCGP’s annual reports became ‘…long on smiling faces and much shorter on facts.’ He also offers practical advice, such as on the professional approaches from the Royal Colleges to government. These need a carefully prepared document with five components a) how standards of care for patients are a problem, b) how resources or support from Government could improve them c) an offer to work in partnership with Government including making changes in the profession to improve quality of care d) a solid team of Colleges in support and e) in private, an analysis on what responses a Government might make.
He also offers practical advice, such as on the professional approaches from the Royal Colleges to government.
The autobiography covers his professional career with copious references to the evidence that has driven his clinical practice. There is not much that he has not done. His professional memories record a fortunate life, and the inside story of how he played each game. This is told in detail with 50 chapters in ten sections and 462 pages following his career. There are many heroes and a few villains. His exceptional memory, written records, and press cuttings provide rich details, making the book an engaging rather than a difficult read. It is a collection of short stories. Each has a theme and sometimes a time-period. Chapters include stories about the Early Years, Chess, being a Medical Student, a Junior Doctor, His Practice, Learning the craft, The South West of England, The BJGP 1968-1980, The Exeter publishing story, The RCGP executive 1970-1980, The University of Exeter, Regional adviser in General Practice, The Downs and Ups of Institutional Life 1982-1987, Chair of RCGP 1987-1990, Fellowship of RCGP by Assessment, Prison Medicine, Chair of RCGP Research 1993-1996, Chair of Joint Committee on Postgraduate Training for General Practice 1994-1997, membership of the General Medical Council, Non- Executive Director of NHS, President of RCGP 1997-2000, Chair of Academy of Medical Royal Colleges 2000-2002, achieving Clinical Excellence Awards for Senior Academic GPs, Patient Participation, The Nuffield Trust 1993-2006, An unfinished Campaign 2013-2023, General Practice as a Learning Environment, and finally his Reflections. Many chapters reveal the reality of successful medical politics: to look like a duck – being calm on the surface but paddling furiously underneath the water. As with any biography not everything he believes may be agreed but that does not ruin the stories.
Over those last 50 years General Practice emerged as a discipline.
GPs who worked in his era will want to read this for an insight into what was happening behind the scenes and how the battles to change general practice were either won or lost.
Anyone currently working in general practice who is, or aspires to be, an effective influencer should read this to learn what it takes to make the changes to improve health care. It also explains what has often been lost from the institutional memory of organisations – learning from past experience.
Not everyone will agree with his vision for general practice, but its reasoning is stated clearly so can inform the past, current and next generation of GP leaders.
Featured book: Denis Pereira Gray, Just a GP: Diaries from a Career in General Practice, Published by CRC Press 2024, Paperback, ISBN -13 978-1032522722, Price £34.97
Featured image by Andrew Papanikitas 2024
