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British general practice: another Collings moment?

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6274 (Published 21 October 2014) Cite this as: BMJ 2014;349:g6274
  1. Veronica Wilkie, professor of primary care, Institute of Health and Society, University of Worcester, UK
  1. veronicawilkie456{at}btinternet.com

It took an outsider’s report to publicise primary care’s failings in the 1950s; what will it take this time, asks Veronica Wilkie

In 1950 the Lancet published a report by JS Collings that described the standard of British general practice as appalling.

Collings, an Australian researcher who had worked in New Zealand and Canada before doing his ethnographic research, sat in at 55 practices for four days each and concluded that GPs were marginalised, excluded from hospitals, and declining in status. He described rural practice as “an anachronism,” suburban practice as “a casualty clearing service,” and inner city practice as “at best . . . very unsatisfactory and at worst a positive source of public danger.”1

The paper was controversial and led to the Hadfield report, commissioned by the BMA,2 which was a more measured attempt to stem the rising criticism of British general practice. Hadfield still showed it to be demoralised and massively underpaid by the new NHS, but not (as intimated in the Collings report) to be a service with no future in a modern health service. The Collings report was a wake-up call and led to several initiatives, including the Royal College of General Practitioners and the development of group …

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