Review

Caring and changing

CONTEMPORARY PRIMARY CARE: the challenges of change
Philip Tovey (ed)
Open University Press, 2000, £18.99

This book, which covers three sets of challenges in primary care – context and organisation, practice and research – has a lot to offer. I found the latter two topics particularly stimulating. A number of current issues are covered including genetics, services for older people and appropriate research.

There is a rigorous and positive chapter by Arblaster and Hastings about the potential for targeting effective primary health care to people living in deprived areas. They provide a good review of the literature on socio-economic inequalities and suggests thoughtful strategies for going beyond the inverse care law, which address resource issues, interventions of proven benefit, the need to develop health workers’ networking skills and ideas for involving local people. They also argue for the retention of a ‘personal doctor’, which goes against the tide of opinion of much being written about primary care at present.

Contributors and content show a bias towards the interests of GPs. Issues related to other professions working in primary care, and users, are largely absent. The exception is Mercer and Barnes’ chapter on disability, which highlights the gap between provider and user perspectives. They discuss the underdeveloped role of primary care as gatekeeper, which is also addressed by Arblaster and Hastings.

One theme running throughout the book is a commitment to evidence-based medicine and the need to broaden the evidence base available.

Mellor-Clark provides a clear and useful examination of the strengths and weaknesses of randomised control trials in the face of the rapid development of counselling services in primary care. Adams and Tovey argue the importance of greater understanding of how complementary medicine is being integrated into primary care and provide a framework for doing this.

So, all in all, a good read, if dominated by medical rather than broader primary care issues.