Two can play at this game: The History of Primary Care in the UK

I hope that many, many years from now, I will be remembered this way too:


This post falls under the "Remind me what you are doing in London?" category. While Danny is off in the archives, I will be working in the Health Services Research Unit of the London School of Hygiene and Tropical Medicine (henceforth known as The Trop). As many have pointed out, the name of this school is just dripping in colonial history (though to be fair, hygiene and sanitation improvements do more for public health than just about anything). My work will be on a "scoping study" of England, trying to see how general practitioners (GPs) and clinics are providing health-promotion and disease-prevention services. But more on my actual project when I start in August.

For now, I am doing background research on the history of primary care in the UK, how primary care is currently organized, what exactly the National Health Service does, etc. Today I was poking around the website of the Royal College of General Practitioners, which like all good British organizations, keeps great public records of its own history. One of the most interesting things was a collection of letters from the early 1950s, when the College was first starting to take shape. Apparently there were already Royal Colleges of several other specialties, like surgery and obstetrics, but general practice was always considered too mundane or antiquated to share this status. When a group of GPs got together and started floating this idea, they got some really nice letters from other GPs around the country, with very poetic descriptions of why general practice was such an important part of the medical tradition, and why a Royal College of GPs was so important.

From one letter: "It is not popular to insist among doctors that the GP is first and foremost a healer and that his primary aim is to restore wholeness or guide his patients towards health. Health may be undefinable, but is not difficult to recognise if present." And from another: "The general practice of medicine could at this present moment be standing on the threshold of an intellectual renaissance."

Interestingly, this call for the RCGP came about because of the creation of the NHS in 1948. The NHS dictated that GPs were all responsible for a health of a particular panel of patients in their geographic area, but did not allocate any funds for these doctors to meet the needs of their new patients. Underfunded and overworked, GPs started to deliver poor-quality care and became completely demoralized. They could not encourage any high-quality young physicians to go into the field, and there was some question of whether the profession would survive.

Sound familiar??? This is shockingly reminiscent of the "perfect storm" that Cambridge Health Alliance doctor Somava Stout talks about in a recent CNN interview. Lots of new patients getting insurance and entering the patient population (good!), but still difficult to attract young physicians to a career that involves piles and piles of paperwork and will not pay back their student loans in any reasonable amount of time (bad!). I don't think that primary care in the US will spiral like it did in the UK after the NHS came into being, but big changes in reimbursement, plus a culture change around medical education to re-invigorate medical students interested in primary care, are both necessary if we are going to weather this storm. Find out what Primary Care Progress is doing to help!