Unlocking the mystery: the nature and purpose of general practice

Mystery, Iona Heath reminds us, is a collective noun for doctors, as well as an archaic term meaning trade, profession, or calling.¹ Heath wrote The Mystery of General Practice at a time of familiar crisis for UK family medicine. Major, neoliberal, market-driven reform had been introduced to primary health care and precipitated a crisis of morale and a fall in applications to train in the speciality. There was a feeling that politicians and health service planners had failed to understand the nature of general practice and its purpose in relation to health.¹ Nature and purpose are the keystones of consent to medical treatment — the what and the why of any proposed intervention.

Public consent to the future of general practice

The articles in this month’s Life and Times address the nature and purpose of general practice in the UK, in a way that is helpful to policymakers, practitioners, and the public. Armando Henrique Norman invites us to think of general practice as a medical platypus — an animal that appears at first glance to be a bizarre mix of several others and yet is perfectly adapted for its place in nature.² Ben Hoban reflects on the purpose of ‘the GP’, asking if there is one big thing that GPs do or if it emerges out of all the little things, more than the sum of its parts.³ If those parts are taken away piecemeal for others to do is there a core of complexity left for GPs to tackle? Are those parts necessary for the effective recognition and management of clinical complexity?

Policymakers, policy workers

Terry Kemple reviews How Westminster Works… And Why it Doesn’t, a book that illustrates the perverse influences on those who set healthcare policy as well as their relative inexperience of situated realities.⁴ The misunderstanding of the nature and purpose of general practice by policymakers is not helped by a lack of networked and well-communicated insight by the profession itself. Emma Ladds reviews a book that aims to address this, What is a Doctor? A GP’s Prescription for the Future, by Phil Whitaker.⁵ Sinead Millwood, a salaried GP, explores the wherefores of primary care with her own mother, Bernadette Millwood, a senior community nurse and clinical director.⁶ They address a crisis of morale in both primary care nursing and general practice — being valued is about the ability to eat lunch and being respected through parity of esteem, whether in regard to pay or to professional interactions.

A holistic approach

Tasneem Khan unpacks wisdom learned on her first day at medical school, inspired by the ‘Wherefore art thou Romeo?’ line in Shakespeare’s Romeo and Juliet. ‘We need to know our patients’ stories, the “whys” and the “wherefores”’, Khan argues.⁷ Alistair Appleby introduces Critical Realism as a philosophical foundation for medical science and primary health care.⁸ The patient’s story and their physical data are part of one undivided person. I review Ayan Panja’s The Health Fix, a book that aims to share a straightforwardly holistic approach to health with the public.⁹ I find it refreshing how the book begins with the author’s reflection on his own health — GPs are also (for the time being) human.

So what?

As Heath argued, the consequences of failing to understand the mystery — the nature and purpose of the trade, profession, or craft — are dire. Saul Miller reflects that confidence in the future of NHS primary care is low but there is concern for the resilience of individual GPs.¹⁰ Addressing resilience but neglecting the root causes of systemic problems affecting primary care feels ignorant or insincere. And the very observation of problems by our electronic and print media may itself have an effect. Richard Armitage wonders if media coverage of A&E pressure could be a potential driver of A&E admissions.¹¹ This is a phenomenon previously associated with political communications, and worthy of study.

One has to wonder what aspiring GPs and GP trainees are thinking. Alex Burrell reflects on the moral agonies of planning an early GP career.¹² Should one prioritise addressing the most public needs or personal survival? If general practice is to have a future, it needs policymakers, the profession, and the public to understand the nature and the purpose of what they are consenting to.

References

1. Heath I. The Mystery of General Practice. 1995. https://www.nuffieldtrust.org.uk/sites/default/files/2017-01/the-mystery-of-general-practice-web-final.pdf (accessed 7 Mar 2024).
2. Henrique Norman A. Embracing general practice’s inner platypus. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736869.
3. Hoban B. One Big Thing. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736881.
4. Kemple T. Books: How Westminster Works… And Why it Doesn’t. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736953.
5. Ladds E. Books: What is a Doctor? A GP’s Prescription for the Future. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736941.
6. Millwood S, Millwood B. From mother to daughter: imparting general wisdow from a career working in general practice. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736905.
7. Khan T. Wherefore art thou? Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736845.
8. Appleby A. Right idea, wrong science? Should Critical Realism be the new science of medical practice? Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736857.
9. Papanikitas A. Books: The Health Fix. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736965.
10. Miller S. The inverse confidence law. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736977.
11. Armitage R. Media coverage of A&E pressure as a potential driver of emergency admissions. Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736917.
12. Burrell A. GP careers: diving in at the Deep End? Br J Gen Pract 2024; DOI: https://doi.org/10.3399/bjgp24X736893.

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