This innovative and timely book draws on pioneering precedents, basic principles, current examples and international experience to capture the narratives, examples and ideas that underlie and demonstrate the exceptional potential of general practice:
"If health care is not at is best where it is needed most, health inequalities will widen."
"The unworried unwell are not hard to reach but they are easy to ignore and are often ignored."
"With patient contact, population coverage, continuity, coordination, flexibility, long term relationships and trust, general practices are the natural hubs of local health systems."
"… practitioners … are not only scientists but also responsible citizens and if they did not raise their voice who else should?"
Written for family doctors looking to strengthen local collaboration, it brings together the traditional strengths of consultations, caring, continuity, coordination and coverage with the current and future challenges of building capacity, community, creativity, consistency, collegiality and campaigning. It highlights the critical importance of working with patients, maximising the use of serial encounters, integrating care, joint working between practices, social prescribing, community development and advocacy based on patient and practitioner experience.
Drawing on the highly-regarded work of Deep End GPs serving the poorest communities in Scotland ̶ www.gla.ac.uk/deepend ̶ the book is an invaluable handbook for all primary care doctors, irrespective of health care system or country, seeking to provide unconditional continuity of personalised care for all patients, whatever problem or combination of problems a patient may have.
Table of Contents
1. The Exceptional Potential of General Practice. 2. Three Horizons of General Practice. 3. Traditional Strengths. Gatekeeping. Tolerating uncertainty. Knowing the patient. Consultations. Caring. Continuity. Coordination. Coverage. Clinical generalism in Scotland. 39 years in practice. 4. Pioneers. Pioneers in research. Edward Jenner. Sir James Mackenzie. William Pickles. Seizing opportunities. University-based research. Population medicine. Career advice for medical students. The example of Julian Tudor Hart. Advocacy. Lachlan Grant. Direct action for public health. Advocating for a National Health Service. Welfare reform. Alcohol in general practice. 5. Challenges. Confusing terminology. Multimorbidity. The challenges of multimorbidity. Assessing the quality of generalist clinical care. Competing for power and resource. Maintaining sufficient numbers of clinical generalists. The Inverse Care Law. GP views on health inequalities. 6. Practices working together in the Deep End. General Practitioners at the Deep End. Deep End Ireland. General practice at the Deep End in Yorkshire and Humber. Deep End Greater Manchester. 7. Addressing the Inverse Care Law. The Govan SHIP Project. The Deep End GP Pioneer Scheme. 8. Link Workers in General Practice. Best arrangements for link workers. Experience as a programme director. Experience as a host practice. Experience as a GP lead. 9. Community Practice. Drumchapel, Scotland. Dublin, Ireland. Brisbane, Australia. Pittsburgh, Pennsylvania. Ghent, Belgium. 10. Learning Health Systems. Learning health systems. Achievements in East London. Development in East London. 11. Core Topics. The dynamics of family life. The child in the consulting room - What does the future hold? Levelling up in Deep End practices. Mental health. End-of-life care. 12. Learning from Medicine at the Margins.Working with refugees in general practice. Homeless general practice. 13. International Perspectives. Key components of health systems. A general practitioner for every person in the world. Perspective from China. Perspective from Lebanon. Perspetive from Sub-Saharan Africa. 14. Working to Produce Evidence of Change. Rules of engagement. The Deep End Advice Worker Project. 15. Evaluation. Learnings from the Deep End. Towards a framework of learning. 16. Education and Training. Correction of social ignorance. A lifeline for a drowning man. The special needs of preactitioners working in deprived areas. GP training in the Deep End. The North Dublin GP Training Scheme. The South Wales GP Academic Fellowship Scheme. The Deep End GP Pioneer Scheme. 17. Preparations Ahead of Time. 18. Reflection. 19. Postscript. The virtues of the race. A philosophy of general practice. 20. Biographies. In Memoriam: Dr Julian Tudor Hart (1927-2018).
Professor Watt is Professor of General Practice and Primary Care at the University of Glasgow, where he served as Head of Department of General Practice from 1994-2009.After hospital posts in Shetland, Leicester, Aberdeen and Nottingham, Professor Watt sought to combine training in epidemiology and general practice, moving to work with Dr Julian Tudor Hart at Glyncorrwg in South Wales, where they carried out a challenging series of community studies on the effect of dietary salt intake on blood pressure.Moving to the community paediatrics scheme in Edinburgh, Professor Watt completed vocational training at Townhead Health Centre in Glasgow. During the next decade, he established the Glasgow WHO MONICA Project Centre, gained accreditation in public health medicine and worked first as a research manager for health services research in the Scottish Chief Scientist Office and then as a senior lecturer in public health at Glasgow University.Since 1994, he has been Professor of General Practice and Primary Care at University of Glasgow – combining and requiring experience in medical education, clinical medicine, epidemiology, research management and public health advocacy.Professor Watt is Lead Coordinator of the Deep End Project, involving the 100 most deprived general practices in Scotland. He also served as Elected Chair, Heads of Departments Group, UK University Departments of General Practice and Primary Care (2001-2004), and has been the Fellowship Panel for Public Health, Primary Care, Epidemiology, Statistics and Psychiatry, UK Academy of Medical Sciences (2004-2006).
"The Exceptional Potential of General Practice is a book that I will certainly use for academic resources and to bolster the arguments I can make when once again the local Clinical Commissioning Group cuts funding to the sort of deprived area that I work in. But I suspect it’s Berger’s book that I will still give to my students to inspire them about general practice, even though it was written over 50 years ago."
Aneez Esmail- The Lancet
"The book itself serves to keep the torch of general practice burning bright and strong. Rather than provide another overarching academic critique of the value of general practice (community-based primary medical care), Watt provides us with a more illuminating constellation of contributions from GPs at the frontline, academics, and other health professionals who are seeking, through a variety of methods, to realise the exceptional potential that high-quality general practice can provide for those who it serves.
For those already engaged in similar work in whatever form, it provides a useful summary of the founding principles that underpin their efforts, some examples of work elsewhere, and a reminder that they are very much part of a whole."
Ben Jackson - British Journal of General Practice