Review

Change reactions

SPOTLIGHT ON GENERAL PRACTICE
Sally Irvine and Hilary Haman
Radcliffe Medical Press, 2000, £18.95

Two key features of the NHS changes introduced by this government are clinical governance and revalidation. Neither is a new issue but a practice that should have been ongoing – and was in many cases, albeit under different titles. This book is aimed at those involved in primary care, especially those involved with clinical governance and revalidation – professionals who need to respond to this new formalised agenda. The target audience is not solely practitioners and managers, but also commissioners and policy decision-makers.

The initial chapter sets the scene by outlining modern general practice and its approach to health care. It describes ‘diagnostic consultancy’, a tool developed by the authors, which can be used to identify problems and, subsequently, arrive at solutions. The material draws on the authors’ personal experiences of management and GP consultancy in more than 200 practices over the past 18 years.

They liken their ‘diagnostic consultancy’ tool to clinical consultancy, in that its purpose is to identify the true underlying problems in a practice, which are often linked to organisational matters and, especially, the quality of delivery of clinical care. The authors outline methods both for identifying the real issues, rather than the presenting ones, and practice strengths, and suggest ways to take the practice forward, such as by creating an effective primary care team.

In addition, they focus on issues that inhibit relationships and further appropriate development which, consequently, have the potential to hinder implementation of clinical governance and revalidation. A number of examples are given throughout the text to emphasise key points. However, much of the material is centred on four in-depth case studies that are used to illustrate specific issues, including the identification of presenting versus underlying issues and the diagnosis of problems. These are followed by some discussion and, finally, recommendations of actions that could be taken for a given scenario or in similar situation.