Family Practice Vol. 20, No. 4, 360-361
© Oxford University Press 2003
Editorial |
‘New Century, New Challenges’
a Director, Institute of General Practice and Primary Care, The University of Sheffield School of Health and Related Research, Sheffield, UK,
b Department of General Practice and Primary Care, Medical Sciences, Queen Mary’s School of Medicine and Dentistry, University of London, London, UK,
c Professor of General Practice, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Correspondence to N Mathers; E-mail: n.mathers{at}sheffield.ac.uk
Mathers N, Carter Y and Marshall M on behalf of the UK Heads of the Academic Departments of General Practice. ‘New Century, New Challenges’. Family Practice 2003; 20: 360–361.
The recently published report ‘New Century, New Challenges’ from the Heads of Departments of General Practice and Primary Care sets out a vision for the development of academic general practice in the UK.1 It reviews the substantial challenges now facing the academic departments and shows clearly how more investment is essential if general practice and primary care services to patients are to be improved under the Government’s NHS Plan.2
In 2001, there were 31 academic departments of general practice and primary care in the UK compared with 24 departments in 1986. In the period since 1986, the number of professors of general practice increased from 16 to 66, and the proportion of non-clinical staff from 10 to 32%, so that by 2001 there were 128 whole-time equivalent (wte) senior clinical and 41 wte senior non-clinical academic staff. On the face of it, these are substantial increases in staff resources. However, this apparent expansion in the number of departments has been achieved mainly by the redistribution of the existing pool of academic staff rather than a substantial increase in real resources.1 Even with these increases, this only comprises some 5% of senior clinical staff in the UK.
At the same time, the number and diversity of tasks delivered by departments has increased enormously—academic departments are now centrally involved in delivering the core curricula of UK medical schools, and approximately one-third of all practices in the UK (3900) are involved in community-based, undergraduate medical education. GP departments have pioneered innovative teaching and learning methods and have been in the vanguard of the implementation of ‘tomorrow’s doctors’.3 In 2001, departments contributed an average of 9% (inter-quartile range 6–12%) of all teaching in undergraduate medical curricula in UK universities but received <5% of the total Service Increment for Teaching (SIFT) (in Scotland ACT) funding to support this activity.
The results of the 2001 Research Assessment Exercise (RAE) also demonstrated a huge increase in the outputs of the departments, some of whom achieved the coveted 5* status for high-quality, internationally important research. As well as substantial commitments to teaching and research, most academic GPs also carry out clinical work on behalf of the NHS and are, in addition, in increasing demand to fill leadership positions in universities and NHS bodies both regionally and nationally. If all of this academic activity is to be sustained by departments, let alone expanded, there will need to be a substantial increase in current investment which will need to be maintained in the coming decade.
As far as the care of patients is concerned, academic general practice has made and continues to make major contributions to the evidence base for clinical care by GPs and other members of the primary health care team. Despite limited resources, high-quality research has been conducted in many areas, which include help-seeking behaviour, acute illness and chronic disorders, health promotion and disease prevention, the organization of primary care and the primary–secondary care interface. Such research has considered the needs and problems of patients set in the context of their everyday lives rather than disease and organs alone. Its principle concerns are with the causation, prevention and treatment of disease and illness, as well as the development of effective health policies and practices involving primary care. Such research has been characterized by multi-method approaches including qualitative methods, epidemiology, cohort studies, randomized controlled trials and research synthesis, trailblazing true multidisciplinary research. These research programmes have been grounded in the ‘real world’ and have made a real difference to the clinical care of patients and the development of NHS policy. All of this has forged better links between non-academic service-based researchers, service GPs and departments via the primary care R&D networks and capacity development organizations such as the Trent Focus (www.trentfocus.org.uk).4
The cynics might say that academic departments of general practice have been involved in merely creating a discipline of service delivery and, despite substantive efforts by individuals to define good general practice,5 the boundaries of the specialty are continually being redefined.6,7 It is, however, essential that such work in defining the core values of general practice and delineating it from other disciplines continues so that when undergraduate students are considering their medical career, they know what is different and unique about general practice. The strengthening of the evidence base for clinical care in general practice will aid this process.
The challenges for academic general practice and primary care include the urgent need to increase senior academic capacity. The number of senior clinical academic staff compared with the number of service GPs in the UK remains a small fraction of the ratio which exists for all other major clinical disciplines. New senior posts are required to share the task of academic leadership and to provide career opportunities for career scientists, lecturers and research fellows. The academic skills base of general practice must be enhanced, and salary differentials between junior academics and NHS principals reduced if sufficient academic GPs are to be attracted into the departments. There is also a clear need for a well-defined career pathway, not only to recruit but also to retain both clinical and non-clinical academic staff. Only if academic ‘critical mass’ is achieved can policy makers be persuaded of the importance of generalism in an effective and efficient health service.
The ‘New Century, New Challenges’ report sets out a vision of how academic general practice can contribute to meeting some of the many challenges facing the NHS in general, and the Workforce Confederations (WFCs) and Primary Care Trusts (PCTs) in particular. Major contributions are already being made in the areas of workforce development (recruitment and retention of staff, especially in the areas of socio-economic disadvantage) and to continuing professional development in PCTs (service development and the implementation of national service frameworks). The report itself is essential reading for all those concerned with the provision of high-quality primary care to patients and the continuing development of general practice as an academic discipline. This includes not only PCT and WFC Directors, the Chairs of Strategic Health Authorities and those responsible for policy development in the Department of Health, but also the Deans of medical schools.
Primary care needs to remain at the top of the agenda for the modernization of the NHS. The targets of the NHS Plan will not be achieved without a recognition of the importance of research and development within primary care, as well as continuing efforts by departments to set the educational agenda and share good practice with their secondary care-based colleagues in medical schools. Links between service GPs and academic GPs should continue to be developed and the resulting combination be used to provide effective, professional lobbying on behalf of primary care. Only in this way can the discipline assume its rightful place at the centre of the NHS as we enter the 21st century.
References
1 Society for Academic Primary Care (SAPC). New Century, New Challenges: A Report from the Heads of Departments of General Practice and Primary Care in the Medical Schools of the United Kingdom. London: Royal College of General Practitioners; 2002.
2 Department of Health. The NHS Plan. A Plan for Investment. A Plan for Reform. Department of Health Command Paper 4818-1. London: The Stationery Office; 2000.
3 General Medical Council ‘Tomorrow’s Doctors’: Recommendations on Undergraduate Medical Education. London: GMC; 2002.
4 Kernick D, Stead J, Dixon M. Moving the research agenda to where it matters: it’s time to rattle the academic cage in primary care. Br Med J 1999; 319: 206–207.
5 Toon PD. What is Good GP? RCGP Occasional Paper no. 65. London: Royal College of General Practitioners; 1994.
6 Olesen F, Dickinson J, Hjortdahl P. General practice—time for a new definition. Br Med J 2000; 320: 354–357.
7 Heath I, Evans P, van Weel C. The specialist of the discipline of general practice. Editorial. Br Med J 2000; 320: 326–327.
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