Aberdeen students in the pre-NHS era received an introduction to general practice during attachments to the Woolmanhill public dispensary as part of their public health teaching. Between 1948 and the creation of the GPTU in 1967, there was no formal teaching in general practice, although many students fixed up short attachments to north-east general practices on their own initiative during vacations.

1967–1984

In 1967, with a grant from the Nuffield Provincial Hospitals Trust, the university decided to create the GPTU and advertised for a director at senior lecturer/reader level. Forty-four applications were received, the majority from senior north-east general practitioners without academic experience. Applicants from outside the area included several already in academic general practice positions. Ian Richardson was appointed from the local department of public health, bringing to the position substantial intellectual skills and a strong academic record in the field of community-based teaching and research.

His appointment heralded the start of a period of substantial and sustained achievement. An undergraduate programme dependent on significant good will from practices throughout the north-east of Scotland was developed, as was Aberdeen's vocational training scheme which, with twelve places each year, was the largest of its kind in the UK. With Ian Buchan, Ian Richardson carried out a major time-and-motion study of the general practice consultation, an idea later repeated for district nurses and health visitors.

The aims and constitution of the original AUTGP were drafted to promote the academic development of the discipline. The intention was that there should not be any significant element of ‘trade union’ activity, but the problems consequent on the totally insufficient funding of the early departments by their universities and medical schools surfaced regularly at the early executive committee meetings.

Across the NHS generally, the Department of Health was attempting to find a more explicit and more equitable formula for distributing its resources. This led in 1974 to the publication of the Resource Allocation Working Party (RAWP) Report, identifying historical differences between the total costs of running ‘teaching’ and ‘non-teaching’ hospitals. These differences were rationalised as being due to the ‘service costs of teaching’ (SIFT) and put back into the subsequent funding formula on a ‘per clinical student per year’ basis. From the outset these funds were payable only to hospitals. General-practice-based teaching was excluded, and so began our campaign for the provision of an analogous subsidy to meet the extra costs of supporting academic costs in the clinical setting of general practice. In 1974 the sum identified as needed to support hospital-based academic work was around £8,000 per student per year – a sum which had grown to nearly £40,000 per year (nearly £5 billion for the NHS nationally) by the time that first teaching practices (1990) and then departments of general practice (1992) won a share of NHS support funding.

The year 2008 marked the sixtieth anniversary of the founding of the NHS. The first academic department of general practice in the modern era also dated from the ‘due date’ for the start of the NHS on 1 July, when the University of Edinburgh established its ‘academic general practice’ in the former Mackenzie House Public Dispensary within its department of social medicine. By 2000, there were twenty-nine departments of general practice in the traditional medical schools of the UK (the department in Trinity College Dublin has traditionally been included in this grouping). The history of their evolution and development has been interesting but not always straightforward; often a source of frustration but eventually one of achievement and satisfaction. This essay tries to tease out some of the issues that have had to be faced up to on the journey.

Timelines

Within the UK

Following the birth of the NHS in 1948, the highly critical Collings Report of 1950 led to the foundation in 1952 of the College of General Practitioners, one of whose first aims was to see established a department of general practice in every UK medical school. The Edinburgh department became independent in 1956 and its chair followed in 1963. Between 1970 and 1972 three other chairs were established in Scotland. Manchester (1972) led the way in England, but it took until 1995 for all schools to follow. From 1971 onwards regional (postgraduate) advisers were appointed in all UK regions, mostly with connections to medical schools through postgraduate Deans. In Exeter, a postgraduate chair was established in 1986.

Imagine a country whose medical schools do not systematically teach students within the clinical discipline that most of them would work in. Imagine such a country also failing to conduct research into the clinical and organisational problems faced by patients and the doctors working in that discipline. Although it seems unthinkable now, the UK was such a country when the NHS began. This book describes and analyses how the pioneers of academic general practice in the UK and the Republic of Ireland overcame the challenges and obstacles to achieving their vision of ensuring that all undergraduates in every medical school experience excellent education in a research-rich environment.

The editors have compiled chapters from departments across the country, telling the highly variable story about how each made progress within their own context. Support from postgraduate departments, the RCGP, departments of public health and parts of the NHS all played their part. The appendices describe the new medical schools; the crucial SIFT/ACT developments; an integrating perspective; and the transition from AUTGP to AUDGP to SAPC. For many readers the main interest will lie in the story of their own institution but others will see common themes and insights that will help them understand how support for progress can be marshalled within and across organisations to overcome today's challenges.

During the second half of the eighteenth century, Andrew Duncan – then professor of medicine in the University of Edinburgh – proposed and constructed a public dispensary to provide care to the sick poor in the Old Town of Edinburgh and to instruct medical students. From 1890 attendance at one of several public dispensary practices became a compulsory part of the Edinburgh undergraduate curriculum.

As in many UK medical schools, the development of the academic department owed much to the foresight and opportunism of senior academic public health/social medicine physicians. In Edinburgh, Professor Frank Crew recognised that the closure of the public dispensaries at the start of the NHS in 1948 would be an important loss to the education of medical students. In 1947, Richard Scott, then a lecturer in Crew's department and with pre-war experience in general practice, embarked on a project to explore the medical and social needs of families in sickness and in health, and together they sought to establish a ‘laboratory in the community’ to provide teaching to medical students and for long-term studies of illness within families.

So, on the first day of the NHS in July 1948, Richard Scott together with a medical assistant, an almoner, a nurse and a dentist set up an NHS practice within the Royal Public Dispensary in West Richmond Street. By 1951 some thirty medical students each year were being provided with a three-month course of clinical instruction, and in 1952 the Rockefeller Foundation offered financial support to aid the development of general practice as an academic discipline.

In July 2007, the Heads of Departments group of SAPC invited those of their retired predecessors and founder members of AUTGP they could trace to join them for their annual get-together in an Indian restaurant in South Kensington. Anxious to repay their hospitality and recognising that many of our stories of the early struggles and setbacks along the road to where we were now had never been properly recorded and were in danger of being lost, our cluster of veterans agreed to write about the early developments of our respective departments. Four years on, this book is the result.

Predictably, our writers did not want to be constrained by any particular format, although we originally signed up to a target length of around 1,000 words. At the end of two years we had six essays in; twenty-five to come! A number of founder heads were no longer with us, or no longer able to contribute, so we set about finding deputies. The original London schools proved a particular challenge, having been so complicated by later mergers and their earliest roots often hard to trace. Some of our most compelling essays have been written in the first person, but most are in the third person. Some were well over our target length; in some we identified important gaps; and some were referenced although most were not. Most problematically, some were concluded (naturally on the retirement of the author) in the late 1970s or early 1980s before other stories had started.