London general: 70 years of improving life in the Capital
NHS general practice is celebrating its 70th birthday, which is a major milestone in the history of British medicine. The availability of general practice to Londoners (8m of us in 1948, 9m now, but as few as 6.5m in the 1990s) has been the bedrock of the NHS since its founding, providing cradle-to-grave care to all families, including those in the most deprived communities.
With 90% of NHS contacts taking place in general practice, GPs and practice teams are the face of the NHS throughout the Capital. Recently the Government announced a £20bn investment in the NHS, but from past experience little of this will reach the frontline of general practice. It is likely to be, as with much of our history, the hard work and dedication of the whole team working inside each GP surgery that delivers the next 70 years’ of success. So, on this significant birthday I would like to reflect on what general practice has achieved.
Universal coverage
Thanks to the development of NHS general practice, more and more people are now in regular contact with their GP:
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91% of patients trust their doctor, with doctors and nurses being the two most trusted professions in the UK; and
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84% of patients are very satisfied with their GP.
Eradicating disease
Before the NHS many people were dying from preventable ailments such as diphtheria or tetanus. Today the children have access to universal vaccination programmes, delivered by general practice:
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125,000 children are born in London each year, all have access to vaccinations from their GP;
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polio was officially eradicated in the UK in 1988, following three decades of vaccination work; and
Longer lives
Average lifespans have grown substantially since 1948, with the work of general practice meaning far more people are living decades beyond retirement age:
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today 65-74 year olds represent 51% of pensioners and over-85s now represent 14%;
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general practice is still fighting to close the lifespan gap between rich and poor, with people in Kensington and Chelsea still living on average four years longer than those in Tower Hamlets.
A diverse workforce
Over the past 70 years, the NHS has transformed into being among the most diverse workforces in the world, currently a quarter of NHS staff working in London are from outside the UK and general practice draws its talent from across the globe:
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764 qualified in the Europe Economic Area;
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3,434 GPs qualified elsewhere in the world; and
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48% of registered GPs and men and 52% women.
The enduring role of the family doctor
These achievements are impressive and a testament to the way general practice has developed with the NHS, but the values of general practice have rightly remained the same. A report from 1948, titled Public Health in 1948: Remarkable Statistics: the first months of the National Health Service paints a picture that GPs and practice teams would recognise today, although now we do have equal numbers of “his” and “hers”:
“The success of the family doctor service depends primarily on the family doctor's relationship with his patients and that is not changed merely by an alteration in the method of payment for service. The administration required is far less than in the other branches. The service has been extremely popular with the public and it seems that despite the size of the undertaking and despite the uneven distribution of load which follows from the present distribution of doctors, the family doctors carried it successfully through its first year.”
The clinical team is made up of GPs, nurses, advanced practitioners, healthcare assistants and numerous new roles delivers so much more than the sum of its parts. Triaging, advice on self-care, diabetes management and many other tasks have been passed from GPs to skilled colleagues. The support they received from practice managers, administrators and reception staff enables the clinical team to take on these wider roles and helps to relieve much of the bureaucratic load which the powers-that-be choose to impose.
Last updated : 05 Jul 2018
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