8th Julian Tudor Hart Lecture 2014: Include me out, exclude you in.

Abstract

The first half of my title comes from Samuel Goldwyn, the Polish American film producer who sometimes struggled with the English language. The second part I added myself, for reasons which will become clear. As a film producer Goldwyn was in the business of telling stories. My first story comes from Fahrenheit 451 , the book by Ray Bradbury and film by Francois Truffaut, whose title records the temperature at which paper burns. In a totalitarian state where books were burned, each member of the resistance was tasked with remembering one book, to keep its story alive. As the future of primary care depends so much on health practitioners, and how they see their work, the Glyncorrwg story is one they need to know, not only how it started, but also how it may carry on. So much of what Julian Tudor Hart pioneered at Glyncorrwg, a former mining village in South Wales, is orthodox now. He was the first doctor to measure the blood pressures of all his patients.1 Famously, the last man to take part had the highest blood pressure of all, which remains an important teaching lesson. Julian and his wife Mary put their records into shape, converting from Lloyd George to A4, and then to computerised records, to establish the information system that allowed them to start by screening the records, not the patients; and to measure what they had not done (the ‘measurement of omission’),2 so they could describe, address, and reduce the ‘rule of halves’.3 Later, Julian could describe a cohort of patients with hypertension diagnosed at <40-years-of-age and followed up over 20 years;4 be ‘his own coroner’, reviewing over 500 consecutive deaths in general practice;5 and assess his impact on premature mortality after 25 years of practice.6 …