Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
French general practitioners went on strike today. It’s part of an extended period of industrial action that includes refusing to process paperwork and a number of planned medical centre closures. Not every GP could participate today, however, due to a flu epidemic sweeping across France. Doctors had already closed their offices during December but there was little response from Marisol Touraine, the Minister for Health, and this was part of their planned efforts to maintain pressure.
Amanda Howe is Professor of Primary Care at the University of East Anglia in Norwich - one of the newer medical schools in the U.K. She is also a GP, Vice Chair of Council at the RCGP, and President-Elect of the World Organization of Family Doctors. She writes here in a personal capacity.
When I starting out as a junior researcher, the big fight was to get primary care research into the universities and the big national and charitable funding streams. The first professor of general practice took up post in 1962, and by 1992 when I became a lecturer, most medical schools had a department of general practice (‘family medicine’ in other countries). But all my seniors still talked as if they were fighting an uphill battle – treated as a minority group, outsiders, less powerful, less well funded, and with a tide to turn against the biomedical ‘lab to bedside’ paradigm.
20+ years on, I am not sure whether that victim voice still needs to be heard. There are some amazing big research units now in U.K. – the School of Primary Care’s member departments all punching above their weight, far more applied funding going into primary care and epidemiological work via the National Institute for Health Research, and medical schools being complemented by nursing and allied health units with excellent track records of their own research.
But some medical schools have put their GP teachers into medical education departments, and made their GP researchers a small part of a ‘big’ health services research unit. And others try to establish a research profile and national/international impact with fewer than 2 full-time academic GPs (my own unit). My ‘Primary Care Group’ also contains brilliant bright colleagues from public health, health economics, sociology and ethics – and the university sees this as a good mixture for applied methods research - but it is not much capacity for clinical work, research, teaching, and academic leadership.
Helen Carr is a General Practitioner in Guildford and a Visiting Research Fellow in the Department of Health Care Management and Policy at Surrey University in the United Kingdom
“Research? We don’t do that in this practice!”
This was the dismissive comment made by one of my GP colleagues in the suburban practice where I am a salaried GP in the south of England. “Sad but harmless,” was the response from my research boss when I asked him about how his GP colleagues viewed his research activities.
I am fairly new to the big wide world of primary care research, and couldn’t give you an accurate assessment of its state in England, but I can tell you what it looks like from where I’m sitting in my practice near London. It’s definitely been a minority sport round here. Most people are fascinated but somewhat surprised when I mention my involvement with Surrey University, and most seem to associate it with eccentricity, boring minutiae or white lab coats.
That’s it, you see. We are near London, not in London; not far enough away from London to have our own medical school, yet full of GPs who are working hard and near breaking-point just running their clinical practices within the current political and financial pressures, with no time or head-space to take much interest in anything else. ...continue reading →