The changing fortunes of community medicine

Abstract

The paper focuses on the possible directions for community medicine in the wake ofthe Griffiths Report. The policy documents of the early 1970s are reviewed briefly to show the emphasis policymakers placed in the management role of the community physician and the inbuilt tensions between this and the perceptions of the community physician's role as advisor and community advocate. Trends in the policy documents of the 1980s show a movement away from the framework set up in 1974 and a consequent diminution of interest in the contributions of the community physician. Against this background, interviews with 43 practising English community physicians are used to establish first, the variation in perceptions of the community physician's role, and second the range of opinions regarding the future of the specialty, from a desire to see community medicine move in the direction of an updated public health, to the belief that the advisory role of the community physician will become predominant after the appointment of general managers. Finally, the problems inherent in a diminished management role are explored in terms of the possibility of reduced visibility and security of the specialty.