Practice Matters

The UK National Health Service is always in crisis, yet it has been shown, 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 vital, influential spearhead. The book explains how and why these changes came about. It is the first such account written by a GP whose career spanned that time, and who writes in detail of his own experience of those dramatic advances. Laced with anecdotes that range from the farcically funny to profoundly sad, the book is part personal memoir, part an outline of the service's history, and part a description of change: of political intrigue, innovations in buildings, staff and technology, and of the pioneering, individual initiatives that led to the development of modern general practice. As an example of the way general practice has developed, the author traces the history of his own. He starts in the days of the Crimean War when one of the practice's doctors worked in Scutari hospital with Florence Nightingale. He then moves through the reasons why the NHS was established in the middle of the twentieth century, and on through its development until 2006. But the remarkable transformation of general practice took place between 1974-2006, and here is an insider's description from within a progressive practice 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 computer and technology projects for the NHS. The book also describes the way some practices worked together in the 1990s to develop local services whilst adhering to the 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, much of the DNA of those projects can be found in current Clinical Commissioning Groups. 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 draw conclusions from those experiences and to offer ideas about how the service could be developed to make the best use of the resources available to it. Anyone wanting the NHS to prosper, whether they work within it or use it as a patient, need to know more about it in order to argue for its preservation and development. Practice Matters will help that process. And those outside the NHS, whether in the UK or abroad, that take an interest in the past, present and future of the NHS will also find this unique book of interest.