Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He is currently attending the 2016 Primary Health Care Research Conference in Canberra, Australia
“This is the time to be in general practice...This is the time to be in general practice research,” said Steve Hambleton, former chair of the Primary Health Care Advisory Group, a body created to look at options to reform care for people with complex and chronic illness. Steve gave the opening conference address. He spoke about the advisory group's work, their wide ranging membership including family doctors, other providers and consumers, and he outlined three areas that would be major challenges in the future: chronic care, obesity, and preventable disease. Steve also reminded us that those patients with the greatest number of diseases see the greatest number of doctors. The final report, delivered on ...continue reading →
Dr Grant Russell is a family physician, Head of School of Primary Health Care, and Professor of General Practice Research at Monash University in Melbourne Australia.
Every few months, someone writes about the parlous state of academic primary care. It was Domhnall MacAuley’s turn a few months ago, as he lamented that academic Family Medicine Departments lack direction, that there was no market for traditional GP research and the academic GP community is getting more and more distant from the patient and from their clinical colleagues. Domhnall’s concerns extended beyond the walls of the university – suggesting that, across general practice the “concept of personal, primary and continuing care exists only in memory”.
Anxiety about the future of the discipline of family medicine is not new. I remember 25 years ago telling an esteemed GP I was thinking about becoming a family physician, only for the celebrated old doctor to say, “I don't know why you want to – see, general practice is finished.” Others have written, and often, about the state of family medicine since the term first began to be used in the 1940s. Underlying all of this are questions of security – “Are we good enough?” “Do we fit?” “Does anyone listen to us?” ...continue reading →
Grant Russell is a primary care clinician and health services researcher, as well as Head of School of Primary Health Care, Director of the Southern Academic Primary Care Research Unit (SAPCRU) and Professor of General Practice Research at Monash University in Australia. He spent 6 years working in Ontario, Canada
A CMAJ editorial once, famously, described Canada as being the ‘country of perpetual pilot projects’. “Pilotomania” is nowhere better seen than in Canada’s long running experimentation with models of delivering primary care. Given that experiments need some sort of professional interpretation, in 2007 the Canadian Health Services Research Foundation (as it was then) commissioned our team at the University of Ottawa (where I was working at the time) to review Canada’s primary care research capacity. Our report: Mapping the future of primary health care research in Canada, allowed us to unpack what turned out to be a fragile enterprise.
We were particularly struck by the challenges facing the primary care research workforce. Many researchers were isolated, especially those working outside nursing schools or Departments of Family Medicine. While islands of innovation existed, there was little sense of a sustainable system for primary care research and development.