This book does not set out to be a comprehensive account of current dynamics in primary care in the UK. On the contrary, each contributor puts forward what they believe to be 'a particularly pressing issue' in their area of interest . The resulting essays have been loosely grouped into three sections: challenges of context and organisation; challenges of practice; and challenges of research.
The result is a box of academic chocolates. There are soft centres, hard centres and even a few Brazil nuts to crack your teeth on. The editor is a researcher in the school of healthcare studies, Leeds University, and the contributions are largely from academics, social scientists and general practitioners. As Tovey points out in the postscript: 'It has been recognised that primary care has, to date, been under-researched' and that 'there are many issues and themes. . . about which we know very little.' This, then, is a mixed box of those themes and issues - and an unashamedly personal selection.
Dowell, a professor of general practice in New Zealand, and Neal, an academic and part-time GP in Leeds, set out an initial vision, reminding us of the rhetoric of 'a primary care-led NHS' and making clear the policy shifts of the last few years. The overall GP bias is then somewhat remedied by the sole nurse contribution, from Wilson (Leeds University), who perhaps not surprisingly poses some essential questions around power and interprofessional relationships in a particularly thought-provoking piece.
Challenges of practice include an optimistic view of future demographics, seeing a resource within the older population. This is followed by chapters on disability and socio-economic inequality.
Kumar courageously tackles issues emerging from the 'new genetics'- a minefield in healthcare, and one which will increasingly engage primary care.
The final section on research is perhaps the heart of the book. As primary care groups move into primary care trusts the need for an infrastructure to support and make use of research is becoming apparent.
Who will be looking for research on locality planning, counselling and complementary medicine as set out here? How will PCGs and trusts link research and practice?
Mellor-Clark of the psychological therapies research centre at Leeds University, in a piece on counselling, exemplifies the issues. Are randomised controlled trials the only approach, and will primary care continue to provide counselling without that kind of evidence? As a prescription, these 10 tablets (one a day) will help to stimulate strategic thinking in those shaping the future of primary care. But they are likely to produce GP and professional bias unless taken with generous spoonfuls of patient, social-service, self-care and secondary-care perspectives.
Tim Scott Senior fellow British Association of Medical Managers.