Family Practice Vol. 17, No. 4, 283-284
© Oxford University Press 2000
Editorial |
Academic general practice: no time for ivory towers
a Department of General Practice and Primary Care, Queen Mary and Westfield College, Medical Sciences, Mile End Road, London E1 4NS and
b Department of General Practice and Primary Care, St George's Hospital Medical School, Tooting, London SW17 0RE, UK.
Carter YH and Hilton S. Academic general practice: no time for ivory towers. Family Practice 2000; 17: 283–284.
Received 4 January 2000; Accepted 13 March 2000.
The very notion of academic general practice is problematic for some—conjuring up images of ivory towers, and GPs working in sheltered environments, protected from the demands of ‘real’ or ‘front-line’ practice. The academic section of any discipline is marked out by its responsibilities for its ‘futures’ component, i.e. education and research for future practice. Academic general practice is still a relatively new discipline. Its role is to support the development of general practice and primary care through the education and training of medical undergraduates, GPs and primary care staff, and through research activities that will contribute to the evidence base for health care in the community. It works in partnership with networks of teaching and research active practices, and has a multi-professional approach illustrated by the variety of disciplines currently working within academic departments of general practice. These include doctors, nurses, managers, social scientists, anthropologists, statisticians, psychologists and others.1,2 While departments within Universities must account for their existence by satisfactory contributions to research and teaching, the base of academic general practice needs to be broader than this.
As we enter the Millennium, general practice and primary care are facing some of the most radical organizational changes that have been encountered in the lifetime of the NHS. The associated political and service pressures place new demands and responsibilities on individual professionals, related health care organizations and the academic world that assists them. The aspirations of Government for the development of primary care, as set out in the White Paper The New NHS, Modern, Dependable3 and in the Department of Health's publication A First Class Service: Quality in the New NHS,4 place particular emphasis on clinical effectiveness, clinical governance and the application of evidence-based medicine. The evidence base underpinning this hive of activity and decision making is inadequate, as is the current capacity of primary care to generate it.
The 1997 Report of an Independent Task Force on Clinical Academic Careers stated:
"... almost every medical school commented on the difficulty in recruiting academic staff in general practice, and they regard this as a very severe problem, in view of the increasing emphasis placed by both the NHS on moving care into the community and by the GMC on increasing the role of primary care in undergraduate teaching."5
The report acknowledged that some significant improvements in the overall conditions of service would be needed for the profession to prosper. The last few years have seen a range of publications relevant to the further academic development of general practice. These include reports on research,1,2,6,7 including the ‘Culyer’ and ‘Mant’ reports; undergraduate medical education;8 and postgraduate education and continuing professional development (CPD).9 In research, the reports identified a need to expand the research capacity in primary care from its historical low base, where research was poorly funded yet fundamental to the operation of the NHS. Recommendations included the need to: increase the recruitment, development, and retention of R&D leaders in primary care; to increase the number of clinical staff with R&D expertise; to increase the involvement of staff in non-clinical disciplines; and to achieve an evidence-based culture in primary care.
It is also a fundamental premise that R&D is necessary for the development of general practice and for the provision of high quality primary care. Irrespective of current policy climates, R&D in primary care will need to remain high on the Government agenda. The opportunities for primary care R&D are increasing, and the scope for those wishing to become involved is widening. Service and academic practitioners will need to work together to meet these challenges.
Thus, there is a need for training opportunities for GPs, and for a range of flexible career pathways to enable them to contribute effectively to the new agenda. The progress towards establishing a career structure for academic general practice has, however, been slow.10 Before the Royal College of General Practitioners was founded in 1952, there were no courses for GPs in research methods or funds to support them.11 The first University Department and first Chair were established in Edinburgh in 1957 and 1963, respectively. Each of the undergraduate medical schools in the UK now has an academic Department and Professor of General Practice. Additional senior appointments increasingly are being made for Professors of Primary Care Research. Postgraduate general practice education has developed steadily over >20 years, and a range of careers, predominantly part time, has been established, with most Postgraduate Directors now holding full-time posts. However, not all academic GPs aspire to become Professors or Directors of Postgraduate General Practice Education—nor is it desirable that they should do so. What is required is an increase in career pathways to enable GPs to pursue educational and research opportunities within future primary care trusts and health authorities as well as in the more established academic departments.
Many academic departments now provide relevant education and training, with an increasing number of diploma courses and masters degrees being developed for postgraduate students. Courses have been responsive to the changing needs of primary care and aim to offer modularity with improved accessibility and a menu to allow personal development in teaching, research and a range of contemporary issues.
Evidence suggests a growing reluctance of vocationally trained doctors to commit early to full-time GP principal posts, and this has led to the promotion of post-VTS educational schemes.12 New posts are being created for GP registrars and young principals with protected time for development and research. Flexible posts with linked clinical and protected academic sessions can aid recruitment and retention of GPs in inner city practice.13 Young doctors particularly are expecting flexibility with a choice of entry routes into academia and established career pathways. A number of opportunities exist which enable junior staff to develop their research skills, under the personal supervision of a senior academic, whilst undertaking a research project related to general practice.14
Changes in undergraduate medical education have brought about greatly strengthened teaching links between Universities and general practice. In the last 2 years, expectations have been raised that the implementation of the new R&D support for NHS providers will facilitate the provision of a greater research infrastructure in primary care.6 Many academic departments are now linked to primary care research networks. These relatively new networks are gaining support and momentum around the UK, their number now exceeding 30. They will need to provide access to research expertise, co-ordination of multi-centre research and dissemination of R&D output.1
This is a time when mutual support and respect are needed within different components of our discipline. Solutions need to be found not only to bridge perceived gaps between academic and service practice, but also for more effective collaboration between undergraduate departments and the postgraduate education network. Joint accreditation of practices for undergraduate and postgraduate education could offer one model for doing this.
Education and research are only two elements in achieving high professional morale and high quality clinical care in general practice, but they are both important and powerful. Primary care has the opportunity to lead the NHS in involving patients in open and informed decision making about their care. Partnership between academic and service practice will help to secure the knowledge base that is necessary to grasp the current opportunities.
References
1 Mant D. R&D in Primary Care: National Working Group Report. Leeds: Department of Health, 1997.
2 Pearson M. Developing Human Resources for Health-related R&D: Next Steps. 2000, in press.
3 United Kingdom Parliament, Secretary of State for Health. The New NHS: Modern, Dependable. London: The Stationery Office, 1997.
4 Department of Health. A First Class Service: Quality in the New NHS. London: Department of Health, 1998.
5 Committee of Vice Chancellors and Principals. Clinical Academic Careers: Report of an Independent Task Force, July 1997. London: CVCP, 1997.
6 National Health Service Research and Development Task Force. Supporting Research and Development in the NHS. London: HMSO, 1994.
7 Medical Research Council. MRC Topic Review: Primary Health Care 1997. London: Medical Research Council, 1997.
8 NHS Executive. SIFT into the Future: Report of the Advisory Group on SIFT. Heywood: Health Publications Unit, 1995.
9 Department of Health. A Review of Continuing Professional Development in General Practice: A Report by the Chief Medical Officer. London: Stationery Office, 1998.
10 Association of University Departments of General Practice. A Career Structure for Academic General Practice. London: AUDGP, 1993.
11 Royal College of General Practitioners. Forty Years On. The Story of the First Forty Years of the Royal College of General Practitioners. London: RCGP, 1992.
12 van Zwanenberg T (ed.). GP Tomorrow. Oxford: Radcliffe Medical Press, 1998.
13 Smith F, Fuller J, Hilton S, Freeman G. The London Academic Training Scheme. Fam Pract 1998; 15 (Suppl): 40–44.
14 Lester HE, Carter YH, Dawood D, Hobbs FDR. Survey of research activity, training needs, departmental support and career intentions of junior academic general practitioners. Br J Gen Pract 1998; 48: 1322–1326.[Web of Science][Medline]
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