What is good general practice? Recollected.

Abstract

‘How to move from managing sick individuals to creating healthy communities’ , the editorial earnestly intoned.1 Luke Allen et al went on to argue the case for reorienting the NHS towards prevention, upon which less than 5% of the health budget is currently spent. Social determinants, after all, account for up to 90% of health outcomes. They suggested, among other things, that practices should work alongside public health teams proactively to engage with local communities in furtherance of health promotion. So far, so comprehensible. In the opinion of many readers, I suspect, they then departed Planet Earth: ‘We need a greater focus on fundamentally changing the physical and socio-political structure of society … ’ Really? There are several reasons why their call will go unheeded, notwithstanding a long tradition of public health in general practice (or, for that matter, strong arguments for changing the structure of our society). Few have ever embraced the role of Tudor Hart’s community physician.2 In part, this is because Allen et al ’s vision is essentially ideological. Public health inclines to centralisation and is largely ‘left wing’. GPs, on the other hand, are politically heterogeneous. Closet ‘Corbynistas’, they are often working in inner cities, rubbing shoulders with more reactionary colleagues from the shires. Vulgar caricatures, of course, but GPs are understandably suspicious of grand plans. The utilitarian values underpinning population-oriented care and budget-holding are sometimes at odds with the individualistic nature of the doctor–patient relationship. Then there is the ever-present problem of time. Allen et al suggest that GPs engage with Health and Wellbeing Boards, Joint Strategic Needs Assessments, and Better Care Fund activity. Even without spare …