TROUBLESHOOTING IN GENERAL PRACTICE

FT Healthcare 191 pages pounds17.95

HEALTH AND SOCIAL SERVICES IN PRIMARY CARE

An effective combination

Edited by Geoff Meads

FT Healthcare 133 pages pounds19.95

BETTER BUILDINGS FOR BETTER SERVICES

Innovative developments in primary care

By Jackie Bailey, Caroline Glendinning and Helen Gould

Radcliffe 104 pages pounds15

With uncertain times ahead for the NHS - and general practice in particular - we have three books that seek to supply a vision and an understanding that may help NHS professionals acknowledge that they will need not only all of their innovation and commitment to succeed, and a willingness to surrender some sovereignty, but a pragmatism to try to work within the framework of the reforms.

The expertise and vision of the authors illuminates general practice into the millennium, helping to highlight the exciting 'big picture', and the potential pitfalls of imposing dogma on a group of powerful medical professionals. Throughout the history of the NHS, these professionals have shown a collective and determined reluctance to be managed and organised.

Troubleshooting in General Practice is a well written and presented book. It is blunt, with a logic and focus that will appeal to primary healthcare professionals. It is humorous and punchy and deals with visions that are 'pure general practice problems'.

The author is a person of wide experience. She used not only to work in general practice, but also spearheaded IT and general management principles to the reluctant and sometimes unwilling. Her understanding of the rich and diverse culture that abounds in a multidisciplinary team, and the sometimes incomprehensible power bases and struggles that go on within it, are refreshingly acknowledged and explained.

Patients' needs and expectations are addressed superbly, particularly in relation to the rise of consumerism, technology, and education and training. So, too, are the often unaddressed issues of trying to meet expectations when they are unattainable (or simply inappropriate), and subsequent appeasement and knee-jerk responses. Everything you need to know about problems in general practice is in this book, from computers to premises and paperwork, with the author suggesting that the culture should not just be one of efficiency and teamwork but also of shared ethics and expressed values.

Perhaps the most dynamic chapter deals with the future. It focuses on the changing role of the clinician, the development of state-of-the-art practices, the use of sophisticated computers - and the dramatic effects these changes will have on individuals. Because the millennium practice will be staffed by real people, it is likely to suffer the same types of problems as today's practice.

The author asserts that 'perfection is an unrealistic and unattainable goal'. As overt rationing of healthcare becomes inevitable, it is likely that this will prove to be the case. This book is certainly a clear and practical guide to the problems facing general practice now and in the future. It is most decidedly timely.

The second book, Health and Social Services in Primary Care, is not an easy read, so be prepared to make notes. The contributors are well respected service innovators, and the issues discussed have been with the NHS since its birth and are some of the most difficult to tackle and solve.

They are dealt with here in an inspired way by the editor, and this makes the book all the more rewarding.

With individual needs assessment, devolved budgets and care management principles being driven across both health and social sectors, this raises many questions on what makes the most effective combination. Surely no healthcare professional would seek to quarrel with the concept that the integration of primary and social care is critical in enabling individuals to live well with conditions for which there is no cure?

However, what the 'experiences' in this book clearly demonstrate is that, for integration to be successful, there has to be considerable corporate leadership and commitment in both health and social care.

There also needs to be a particularly magical component in general practice that is both leading edge and democratic in style and management.

It is perceived, perhaps correctly, that the conflict of culture and communication between health and social care has been a barrier to integration, but 'experiences' clearly demonstrate that where there is a will, there is often a way.

Stephen Henry, one of the committed visionaries promoting integration, is still something of a rare breed in general practice. Certainly, his democratic style is not easily reproduced, but the actual process of working towards integration seems to build confidence and understanding on which significant and lasting service changes can be founded. This is definitely a lesson that could be taken on board by general practice and health authorities alike.

The authors maintain that general practice should be a major driving force in shaping and providing services, and that more integrated local provision across health and social care will generate gains for local people. But this concept requires considerable culture changes at HA and practice level.

There needs to be strong focus on well-managed, large-scale healthcare teams. In addition, budgets will need to be linked to publicly recognised and accepted systems of accountability.

This is definitely not a book for the faint-hearted, but a must for all healthcare professionals and GPs - and their managers in particular.

Better Buildings for Better Services is a bread-and-butter book for anyone in general practice seeking to improve their premises to take account of the new developments in primary healthcare and the demands these will place on buildings. It also looks at how to obtain the necessary funding.

The authors examine the issues that will inform future decision making for developing primary care. They rightly assert that, as professionals who have previously worked in separate locations move into the community, premises will need to be developed accordingly. Interestingly, they also envisage there will be a need for accommodation for local voluntary groups whose involvement is a key feature of the new government's reforms.

GPs will remain at the heart of primary care services and their traditional funding will remain. But this book looks at different funding strategies and gives some exciting and innovative examples of how

services have been developed and funded across the country.

Importantly, although most of the developments originated in efforts by individual GP practices to find bigger and better premises, the actual processes required many more organisations and service providers to increase the range of services available to local communities and practice populations.

The authors' views on the complexity of funding packages and the inappropriateness of the private finance initiative should be taken on board by HAs and the government. So, too, should their views that pioneering primary healthcare will require appropriate buildings (with HAs playing a vital role in assessing local service needs) and that consequent improvements in service provision should involve a wide range of health organisations.

This book provides a valuable glimpse into the future of primary and community health services, and looks at how services and premises could develop into the next millennium.

The authors, perhaps inadvertently, highlight an important cultural part of general practice: when GPs need to enlist the efforts of other agencies to obtain their own aims and objectives, they are generally extremely successful in doing so.

MO RILLANDS

Chief executive of the Avenues Medical Group, Newcastle.