Shaping tomorrow: issues facing general practice in the new millennium
March 2002
Foreword
General practice is a fundamental part of health care. At its centre is the care provided to people who are ill or believe themselves to be ill, and at its heart a doctor-patient relationship based on mutual trust and personal attention focused on the individual. In the United Kingdom, general practice is highly valued by most patients.
Its cost-effectiveness is founded on the patient list, responsibility for a defined population, the life-long medical record, and access to clinical generalists who co-ordinate care and decide whether referral to a specialist is required. That gatekeeper role is exercised with discretion, and some ninety per cent of health care episodes are entirely handled within primary care. These concepts rightly have an enduring value.
But general practitioners are not hostile to change. We embrace change constantly, whether it is in the field of clinical practice, service delivery or postgraduate education. Primary care teams, an extended range of services in general practice, premises development, vocational training and out-of-hours co-operatives are all examples of changes which have been initiated from within general practice.
As we enter a new millennium, GPs will need to embrace further change, to strengthen and make the most of our GP-led approach to defining an agenda for the future. We need to take stock of what being a GP should mean in the years ahead, what we need from Government and what we expect of ourselves.
This book – Shaping Tomorrow - is part of a process of mapping out possible futures for primary care and initiating debate inside and outside general practice. For over a year the BMA General Practitioners Committee, which represents all NHS general practitioners in the United Kingdom, has been intent on such a policy review. We are not alone in wishing to do so. The Government, the Royal College of General Practitioners and other primary care organisations are also looking to the future.
This discussion document, written by Chris Mihill, is a major part of the GPC’s own policy review process. He has taken wide soundings, from within general practice, throughout the health care professions, and from patients, policy makers and politicians. Chris Mihill sets out the key strengths of general practice, the problems and threats that confront us, and many exciting possibilities and opportunities for change and solutions for the next decade. In many areas there is broad consensus inside and outside general practice. In others there is a plethora of ideas but as yet no defined way forward.
The book is being sent to every GP in the UK, and to politicians, managers and health care and patients’ organisations. I hope that Shaping Tomorrow will lead to and inform a wide process of discussion and debate, not just in local medical meetings throughout the country, but also outside the profession. The General Practitioners Committee’s first ever conference in Harrogate on 15 March this year – an event at which anyone interested in primary care will be welcome - will provide an exciting platform for debating the ferment of ideas about the future for general practice.
General practitioners have never been afraid to take on new ideas, new challenges and new ways of working. We need to promote and strengthen general practice in the new millennium, to protect its fundamental characteristics and its pivotal role, and ensure a service of which we and our patients can be proud.
I believe the debate arising from this book Shaping Tomorrow and from GPC Conference 2000 will show us the way ahead for British general practice.
John Chisholm