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This collection of stories from two practising GPs describes the reality of working within a failing and highly bureaucratic system, where there is a balancing act: regulation versus relationships; autonomy versus standard practice; algorithm versus individual attention.
We aren’t suggesting a return to a ‘better’ time. We don’t object to being bureaucrats, embedded within and accountable to the systems we are in. But we do want to consider how and with what the gap left by the old-fashioned GP has been filled. We use stories based on our experience to describe the effect of different facets of bureaucracy on our ability to maintain a nuanced, individualised approach to each patient and encounter; and to question the prominence and effect of protocol. We are interested in the way professional relationships are influenced by protocol: between and within organisations; and most importantly with patients/clients/service users..
We are accustomed nowadays to automated telephone lines, chatbots, website FAQs- the frustration of being unable to connect with another human being who will listen to our particular question and give us something other than a generic answer. The same issues that are facing society at large have changed the way in which we work as GPs and the care we give.
'The book is believably rich in common and plausible (being based on experience) general practice narratives. With apology and credit to the authors I fully intend to ‘mine’ it as a sourcebook for teaching, and as a text to recommend to sixth formers, medical students, foundation years, and GP trainees... Taken as an entire scholarly work (a thesis) the book is a scholarly travelogue of day-to-day activities in general practice from the practitioner’s viewpoint, and as such it can be a lingering and emotional read... The GP reader connects with the narrative archetypes of current practice in the stories. I feel as I read that it is both familiar and strange. You don’t have to feel what the authors are feeling but the stories and the reflections on them are relatable to the GP, and potentially to other kinds of street-level bureaucrat. While the context of the book is very British, I invite colleagues in primary care and other street-level professions to consider that, like a good ethnography, much of the narrative and subsequent reflection is transferable... Fighting for the Soul of General Practice feels like a strong manifesto for the human and humane aspects (the soul) of general practice.'
List of Figures
Acknowledgements
Prologue
Introduction: Standardising General Practice
1. Weaponized Bureaucracy: Bureaucracy as a Source of Injustice
2. Pigeonholes: Medical Categories
3. Guidelines, Tramlines, Mindlines: Interpreting the Evidence
4. Waiting to Connect: Algorithms That Dictate Access
5. Taking Liberties: Regulating the Mental Health Act
6. Passports for Passing: The Bureaucracy of Death
7. A Labour of Love: Why It Is That General Practice Is Still a Good Place to Work
8. Final Reflection – Image Reviewing
Conclusion
Bibliography
Index