ABOUT THE BOOK
The UK National Health Service is always in crisis, yet surveys show, time and time again, that the public value it more highly than anything else in British society. This book is a good-news story about the service, and in particular, about its core - its 7,000 general practices.
Between 1974 and 2006 UK general practice underwent an astonishing evolution, moving from the baggage train of the NHS to become its indispensable, influential spearhead. The book explains how and why these changes occurred. It is the first such account written by a GP whose career spanned that time, and who writes in detail of his experience of those dramatic advances.
Laced with anecdotes that range from the farcically funny to profoundly sad, the book is in part a personal memoir, part an outline of the service’s history, and in part a description of change. It describes innovations in buildings, staff and technology, political intrigue, and the pioneering, individual initiatives that led to the development of modern general practice.
The book traces the history of my practice as an example; it is the one I know most about but it is just one of thousands. Its story starts in the days of the Crimean War when one of the practice’s doctors worked in Scutari hospital with Florence Nightingale. Without attempting to be a formal history of the NHS, none the less, the book then moves through the reasons for the creation of the service in the middle of the twentieth century and describes its early development.
But the most remarkable transformation of general practice took place between 1974-2006, and the book provides a unique, insider’s description from within one of the many progressive practices during those years.
It includes the early days of formal training schemes for GPs, the employment of practice nurses, the construction of avant-garde buildings, and of cutting-edge, national information technology projects for the NHS.
Just as some practices pioneered the concept of GP fundholding in the 1990s it also describes the way other practices worked together to develop local services while adhering to the traditional, core principles of the NHS. Those ideas were at odds with the government’s preference for GP fundholding, and the book describes the difficulties behind their implementation. Though highly controversial at the time, current Clinical Commissioning Groups contain much of the DNA of those projects.
The various parts of the book combine to offer a broad picture of just how general practice has become so important and influential within the NHS. But it also goes on, to provide ideas about how the service could be developed to make the best use of the resources available to it.
All those wanting the NHS to prosper, whether they work within it or use it as a patient, need to know more about it to argue for its preservation and development. Practice Matters will help that process. And those outside the NHS, whether in the UK or abroad, who take an interest in the past, present and future of the NHS will also find this unique book of interest.