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At the heart of general practice since 1960

From General Practice to Primary Care: the Industrialization of Family Medicine

A detailed analysis of the profession's shift from traditional, small-scale general practice to a world of polyclinics and walk-in centres

A detailed analysis of the profession's shift from traditional, small-scale general practice to a world of polyclinics and walk-in centres

I expected to enjoy this book more than I did. I am of a similar generation to the author - Professor Steve Iliffe - who has set out to describe the changes in general practice during his career, or what he refers to as the ‘industrialisation of general practice'.

However, I found the book both over- and under-detailed.

As someone who has lived through these times of change I found some of the fine detail heavy going.

I do not think that a younger practitioner would have got enough of a broad description of the events described to understand what happens; there is an underlying assumption of previous knowledge about the recent changes to general practice.

He begins by giving a history of the recent changes in general practice and compares the UK experience with those of the US and of other professions such as engineering.

He discusses the changing relationships between GPs and the various levels of management within and outside of the practice.

His examination of skill mix, substitution of doctors by nurses and of specialisation produces more questions than answers.

His theme of ‘industrialisation' continues with a chapter on mass production and the current emphasis on performance indicators and micro-management of the consultation.

He challenges some of the thinking around the current ‘buzz terms' of evidence-based medicine and clinical governance.

His personal view is that GPs should try to lead the inevitable changes by evolving and adapting, but I did not get a clear view as to how he felt the profession could achieve this.

I think the author wants to stimulate debate about the future of general practice and how we as a profession can adapt to and manipulate changes to get the best for our patients and for ourselves.

I think few of us are likely to read a whole book on the subject and the point might be better disseminated in a couple of short articles in a widely read journal, maybe even the ‘GP rag mags'.

Dr Clare Etherington

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