Family Practice Vol. 20, No. 4, 359
© Oxford University Press 2003
Editorial |
Academic family practice
Guy’s, King’s & St Thomas’ School of Medicine, London, UK; E-mail: roger.jones{at}kcl.ac.uk
Jones R. Academic family practice. Family Practice 2003; 20: 359.
In many countries, the imperatives of service delivery, the constraints of shrinking resources and the increasing demands of a well-informed yet frequently risk-taking population conspire to threaten the viability of clinical academic medicine. In many countries, Academies are looking hard at ways of making clinical academic careers more appealing and making clinical research more relevant and better supported. The accompanying editorial in this issue of Family Practice describes the current position for academic general practice in the UK, and readers in other countries will, I am sure, find resonances with their own circumstances.
There is a paradox about all this. It appears to be generally accepted that a robust primary care sector is an important ingredient of a health service which is clinically effective and cost efficient, yet, for the most part, research effort and research funding are focused increasingly sharply on the genetic, molecular and technological disciplines. This is not to underplay their importance, but without high-quality clinical research in the setting where most disease is encountered and treated—primary care—and without appropriate attention being paid to issues of translational research, implementation, public and professional behaviour change and the interactions between psychological, social and physical factors in illness, it is not possible to establish and sustain a robust evidence base for practice.
There are further paradoxes in education. As patients spend less time in hospital, where they are sicker and less appropriate ‘material’ for teaching, the need to find alternative teaching settings and teachers becomes more pressing. In the UK at present, around 50% of all GPs are involved in teaching undergraduates or training postgraduates, yet appropriate resources to support the move towards community-based teaching have been slow to follow the enthusiasm and expertise of GP teachers. There is good evidence that clinical teaching can be delivered as effectively in the community as it can in hospital practice and also that the involvement of GPs and their teams in teaching leads to enhancement of clinical skills and job satisfaction, as well as improving recruitment and retention of GPs.
To say that academic general practice, in both its teaching and research incarnations, deserves better support does not seem to me to be special pleading, but a self-evident truth about wise investment in health services. I hope that the comments that I have made here and those made by the authors of the accompanying editorial will echo in other parts of the world and will stimulate you, the readers of Family Practice, to contribute your own thoughts to a growing debate about the role and position of academic general practice in health services and university systems. I would be very happy to hear from individuals or groups wishing to contribute to this debate, by the submission of either original material or well-argued discussion articles.
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