Books

How to be a good enough GP Surviving and thriving in the new primary care organisations By Gerhard Wilke with Simon Freeman Radcliffe Medical Press 224 pages£19.95

One of the great things about all the changes that have taken place in general practice since 1990 is the unlimited potential for bringing out the same published stuff as always.

All you need to do is claim that it is invaluable for adapting to fundholding/the cessation of fundholding/primary care groups/primary care trusts.

The reason for this is simple. Just like the car industry, the NHS has a built-in redundancy that guarantees a long and fruitful life for health publishers. No sooner have you finished your definitive tome On How to Appoint Your Practice Manager, than it is time to read How to Sack Your Practice Manager.

Gerhard Wilke makes no apology for going back as far as the 1950s and 1960s to Michael Balint's work on doctor-patient relationships but wraps it all up in a modern, easy-to-understand language.

He says: 'Primary care is formed by the interactions between the unconscious mind of each primary care group and the social unconscious of the NHS foundation matrix... To use an image from Gestalt thinking: the foundation matrix forms the base of our shared common humanity and the group matrix lends us a distinct cultural and professional identity.' That hissing sound you can hear is Balint rotating in his urn.

Dr Wilke, you may be surprised to hear, originally studied anthropology at Cambridge and his own particular unconscious regression pops up all over the book, which deals primarily with PCG/T interrelationships. Unfortunately, the excellent advice and analysis is almost totally obscured by jargon and longwinded discussion.

I found his section titles somewhat confusing. 'Resolving the Oedipus complex in general practice' is not full of helpful pointers for the next patient who comes in with the word 'mum' tattooed on his forehead, as you might expect.What it actually discusses is the need for strong leadership without a levelling of the differences between members of the multidisciplinary team.

This is a deeply personal and opinionated book, with an average of four first-person 'I's per page - which, at a rough estimate, adds up to around 800 'I did it my way' statements.Yet it makes fascinating reading, if only for the number of words I have never seen before.

On some things Wilke is bang on. In a section entitled 'Working through the trauma of sadomasochistic training', for instance, he states: 'The first trauma [of GPs] is that of them missing adolescence due to the pressures of school. The second is the sadomasochistic training at medical school.'

He missed out the third trauma: that of dealing with successive governments which appear determined to wipe out general practice without trace.

I suspect this book will feature high on the must-read list of the Royal College of GPs. I certainly enjoyed it, especially as Dr Wilke appears to be a true prophet.How else could he know the likely date for the demise of our profession in a section titled 'The midlife crisis of primary care'?

Dr Ian Banks Co Down GP, chair, Men's Health Forum.