This is the second in a series of three books published by Oxford University Press on general practice, and covers the 100 years before the NHS was founded. The first covers medical care and general practice from 1750-1850. The third will look at general practice under the NHS from 1948. The trilogy makes essential reading for anyone wanting to understand the unique nature of British general practice and how it has evolved. Anne Digby employs the analogy of 'social Darwinism' to describe the development of general practice in both rural and urban situations, using a wide range of archive documents, oral testimony and printed sources.
Part one looks at the careers of GPs, starting with the challenges of the last century, including overcrowding, competition and the need for registration and regulation. The development of recruitment and training, with early apprenticeship schemes and changing qualifications, is described.
Medical education evolved gradually, but on the whole medical schools failed GPs and have only recently begun to remedy this situation. As general practice diversified, so the nature of practice changed, as did the roles of GPs.
Part two looks at the organisation of general practice and how it evolved from a cottage industry when medicine was a marketplace and general practice a small business.
The changing organisation of practice is traced in terms of personnel, accommodation and technology, and the increasing contribution of women to general practice is described. As the scope of investigation and treatment changed, so did doctor-patient relationships - in the context of society at the time - in terms of choice, payments and the gatekeeping role of GPs.
Part three considers the wider world of GPs, with descriptions of private lives and public duties in both town and country, and the changing boundaries between generalists and specialists. The importance of doctors' wives is emphasised, as is the poor health and life-expectancy of GPs, especially in the last century and the beginning of this one, when tensions between specialists and generalists led to them being marginalised. The book ends with a description of how national health insurance with panel doctors affected general practice, and how the advent of the NHS was received by the profession.
The approach is comprehensive and inclusive, although there could have been more emphasis on the unique nature of British general practice in terms of being generalists, with lists of patients and a gatekeeper role.
Mane stay: a country doctor doing his rounds by carriage at the turn of the century.
However, this book is a work of scholarship with copious references and footnotes, while at the same time bringing alive the experience of previous generations of GPs.