As Pulse celebrates its 50th anniversary, it is enlightening to look back at what has changed over the past half-century – and what has remained constant
If you wished to illustrate the dramatic changes that have swept through general practice over the past half-century, you could do worse than hold up Pulse's inaugural issue. Those were the days of the gentleman doctor, working as a single-hander from his front room. That gentler, almost exclusively male, world is captured perfectly by our first front page, and its news that GPs' suits damaged on duty would be tax-deductible (or rather ‘deductable' as we said then – it seems even spelling has changed since 1960).
In this golden anniversary issue of Pulse, we trace the timeline of general practice right through the past 50 years. It's fascinating to pick out the major events that have shaped the profession, and the GPs who made them possible. In the 1960s, morale in general practice was rock bottom, and it took the 1966 GP Charter, negotiated by Dr James Cameron, to secure a proper pay rise and investment for staff and premises. The 1970s brought fierce debate about the very future of the NHS, and strong advocates such as the legendary Dr Julian Tudor Hart were critical in maintaining support. The 1980s saw controls over GP prescribing tighten, and the 1990s brought spiralling workload as GPs were landed with a contract rigid in its requirements of them. The controversial 2004 contract, negotiated by Dr John Chisolm, brought tick-box medicine as never before, but allowed GPs to regain some control of their workload.
With all that change, it is easy to lose sight of those elements of general practice that have remained constant over the past 50 years, but there are many. Holistic, continuous care for individual patients has always been at the heart of general practice, and it's the relationship between doctor and patient that makes it possible. Indeed, many of those GPs who our judging panel this week picked out as most influential over the years have been those who did most to describe, and defend, those core attributes: people such as Sir Denis Pereira-Gray and Dr Roger Neighbour. It is the ability of general practice to provide personal care that makes it unique, which is why threats to that central attribute are rightly taken so seriously by the profession.
When Pulse canvassed the views of GPs for our Manifesto for General Practice, there were many frustrations over the current direction of the NHS, but most could be boiled down to just two central complaints. GPs are sick of top-down targets being imposed upon them, and angry at the fragmentation of primary care, with its threat to the core principles of general practice. Yet two pieces of news this week suggest GPs' voices are at last being heard. Pulse reveals that Andrew Lansley, the shadow health secretary, has pledged to halt centralised plans to shift work into primary care, and ensure GPs are consulted locally before any efficiency drives are put in place. And we also learn that one of the Government's flagship, first-generation walk-in centres – so symptomatic of the break-up of primary care – is to be closed, judged wasteful and inefficient. Changes in general practice have been as dramatic in recent years as in any of the last 50, but not every change is for the better.
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