An inspiring book which makes me regret I did not become a general practitioner.
I spent the whole of my medical training in the early 1960s including my 3 years clinical training at University College Hospital without ever meeting a general practitioner or seeing inside a general practice. And when I opted to jump off the consultant ladder after a brief hospital clinical career some five years later I chose public health as my destination rather than general practice which, looking back, might well have been a practical alternative. So reviewing a book about general practice set in Liverpool, a city largely unknown to me, might seem a bit odd lacking as I do any obvious credentials for doing so.
My interest in general practice developed gradually much later starting when I worked at the North East Thames regional health authority in the 1980s where I came across individual GPs from time to time, Arnold Elliott and John Oldham among others, and where I became familiar with the poor quality shop front style of general practice that existed in parts of the East End because of its inevitable consequence for local hospital services. It was remarkable that at that time the involvement of general practitioners in developing the region’s strategic planning of hospital and community health services was, apart from a single practitioner member on the health authority itself, effectively nil.
Later I moved to Norfolk where the standard of general practice was evidently very high and where I met for the first time Julian Tudor Hart, whose writings I had already become very familiar with and admired, at a meeting of the Norfolk and Norwich Hospital Medical Society; and where I worked for several years with Tony Allibone a fellow Health Authority member. Here also I became interested in the Peckham Pioneer Health Centre experiment and as a Pioneer Health Foundation Trustee got to know the Bromley by Bow practice in East London. I then moved to Wales, got to know Julian Tudor Hart and played a part in the roll out of the country’s groundbreaking health, social care and wellbeing strategic planning project. The result for me was a realisation that public health of the wider determinants variety with a focus on inequalities in health, could best be delivered through general practices providing personal wellbeing prescribing and community wellbeing advocacy and activism.
Parallel with this growing interest in general practice, a second personal epiphany was the appreciation that the practice of public health needed to be a political process as much as a technical one based on applied epidemiology. This led me to join and become active in the Labour Party; to become a Bristol City Councillor for a deprived ward in the west of the City which gave me first hand experience of community empowerment; and to join the Socialist Health Association as a local activist and for a period, its Chairman.
So to read about a practice in Toxteth – a part of Liverpool I knew about like most people as a result of the riots – initiated by a distinguished predecessor SHA chairman which seemed to have developed a personal and public wellbeing focused style of practice during difficult times would, I opined, be of great interest. And so it turned out.
The book is a fascinating history of Dr Cyril Taylor’s vision of general practice and its subsequent evolution as a political and community activist wellbeing focused organisation as well as a provider of personal healthcare based on Princes Park Health Centre.
It is the work of two of the Health Centre’s former partners being a collection of impressions and stories detailing the Health Centre’s evolution over 40 years from its opening in 1977
To me a particularly interesting element is the evidence it presents from various viewpoints about the carnage caused to the NHS and general practice by the innumerable reorganisations wreaked by governments of both hues. I lived and worked through many of these. Working as a public health director, however, I was not always aware of their impact on general practice and on primary healthcare.
As a result of my own experience I have formed the view that the NHS is far too important to and valued by the general public to be subject to government interference. What is needed is a new constitutional dispensation which insulates it from tinkering by incumbent governments with little or no experience or understanding of the complexities of health and healthcare delivery and whose main interest is seeking perceived electoral advantage.
But for me the book is particularly important because it demonstrates certainly to my satisfaction that the perhaps idealised vision I have slowly developed of an outward looking wellbeing focused community activist organisation is both realistic, effective and inspiring.
The titles of the 16 Chapters give an inkling of some of the novel approaches adopted by the practice some of which indicated responses to particular local issues that I had not envisaged in my own equivalent model of practice based in rural Wales. These titles include “Battling the Inverse Square Law in the early 1990s”; “The Family Health Project – tackling the needs of homeless people;” “Anti-Racism, ethnic monitoring and health”; “Primary care and public health, a joint agenda;” “Digging deep to tackle deprivation (1980s) subheading A feminist practice.”
The “Primary care and public health, a joint agenda” chapter is of particular interest as it describes a multi-faceted collaboration between local service and academic public health personnel and the practice with some general practitioners even opting to pursue public health careers. I am aware of at least one fellow public health director who did the reverse move. But at the time he made it I did not appreciate how inspired and forward looking this was.
In conclusion a must read for budding GPs and public health specialists and of course for NHS managers and policy makers. It gives a vivid picture of one very important direction for the future of primary healthcare and public health in the UK.
If I had known in 1968 what I know now I would have pursued my interest in public health as a general practitioner when I jumped off the consultant ladder and had a more personally satisfying career as a result!
Paul Walker
(Publishers are Writing on the Wall )