Managing change in general practice: introduction. (Managing Change in Primary Care, part 1)

There is a popular myth, especially evident among politicaians, that general practice is ultraconservative. Little has changed over the years and little will change in the foreseeable future. We are, in short, a cold bed of Luddites.

This misconception derives, I believe, from the fact that, as in all professions, new ideas are treated with healthy scepticism until their worth is evident. Once adopted by a large minority, however, innovations quickly become the norm. Politicians are uncomfortable with this. If they encourage changes they are usually experimented with, evaluated, and, finally, after some time, may be adopted. This makes change unpredictable and slow, so they often opt for a second course, imposition, which in its turn creates problems of acceptance and morale.

The reality is, as every practitioner knows, that change is endemic in general practice-it just may not happen in the way that outsiders would wish. On reflecting back over the past 10 years in our practice the evidence is stark. We have moved from an extension on the back of the then senior partner's house to a purpose built medical centre. Staffing has increased from just two dispensers to include a manager, secretary, data analyst, two practice nurses, and a cohort of receptionists and dispensers. We have seen the arrival of an internal telephone system, pagers, computers, nebulisers, electrocardiographs, defibrillators, and sonic aids. The clinical work has changed …