Review

Who will lead the’primary care-led’ NHS?

MANAGING THE PRACTICE - WHOSE BUSINESS?
June Huntington
Radcliffe Medical Press, 1995, £16.50

The “primary care led NHS” and the “strategic shift from secondary to primary care” are currently the most frequently heard pieces of jargon in health service management. But is management in primary care up to the task? June Huntington’s book goes part of the way to answer this question. Some practices can’t wait to get on with it, others will need an awful lot of support for some time to come. Her book is the second to come from work based on the King’s Fund Primary Care Group. The purpose of the series is to raise the profile of primary care development and discuss ideas and services which are being tested out around the country.

The book is based on a series of workshops attended by over 150 GPs and their practice managers from Wessex in late 1993 and early 1994. The work was commissioned by Wessex RHA and the NHS Women’s Unit to produce an in-depth picture of the development of management in general practices.

The structure of the book is essentially a description of the different workshop sessions - the management function, the practice manager’s role, decision making in general practice, “futures” and management development needs. Those attending the workshops came from a wide range of practices bringing many different perspectives. This means that the book is an excellent description of the range of views on management issues currently held by GPs and practice managers. It is also very practical and clearly based on reality. Many important management issues are raised and dealt with. These include sensitive and difficult areas such as gender issues in practice management, the angry defensive positions adopted by some people threatened with a rapidly changing world and the way many GPs doubt that effective management can help them because they are afraid of losing control.

My disappointments in the book were mainly to do with the lack of discussion of theoretical perspective on management and how that relates to current problems facing managers of primary care. When GPs become involved in management they often experience conflict between responsibility to individual patients and responsibility to the practice, or more broadly to the NHS. Although this is mentioned it could usefully have been discussed in more depth.

This book would be a worthwhile addition to practice libraries. In addition it provides detailed insights into issuesin primary care of which all health authority staff who have anything to do with general practice should be aware.