From General Practice to Primary Care

Anxiety about medicine becoming impersonal and mechanised permeates the NHS. In addition, the popular media is full of stories about the health service and its unhappy staff, focusing on the belief that professionals and patients are being turned into assembly-line workers and objects. This is particularly prevalent in general practice, as plans for massive policlinics are revealed and payment systems shift seemingly inexorably towards incentives and targets. The ethos of familymedicine, which places so much stress on continuity of care, psychosocial understanding of illness, and the careful management of doubt, is challenged by guidelines, governance, quality frameworks, and patient satisfaction surveys. General practice is being industrialized into primary care, or so it canseem. This book explores the many dimensions of industrialization as it has occurred to others in the past, and analyses the origins of the current wave of reform in general practice. It analyses why industrialization is being pursued as a government strategy, and explores its benefits and dangers. It concludes that the medical profession has reasons for being perturbed by industrialization, but that it has advantages as well as disadvantages for the NHS and the public. Its conclusions may notplease either policy makers or practitioners, but they offer ways for professionals working in the community to customise current changes in potentially beneficial ways.