National Conference proposal from Dewar Group

gscNorth of Scotland RCGP Faculty Proposal for themed RCGP Annual Conference in Glasgow 2012

Background

The annual flagship conference for the RCGP returns to Glasgow in 2012. The Scottish hosts wish to celebrate the 100 year anniversary of the publication of the ‘Dewar Report’ at the conference as the main theme and the conference thread for the following reasons:

  1. The Highlands and Islands Medical Service Committee Report chaired by Sir John Dewar, MP and presented to the UK parliament in 1912 is a crucial document in the understanding of general practice in Scotland and current service provision and training.
  2. This Scottish report was presented to the UK Government in 1912 but has modern resonance with devolved health care policy in the UK today.
  3. The report lead to setting up the Highlands and Islands Medical Service which became a test pilot area before the foundation of the NHS in 1948
  4.  The detailed descriptions of health inequality and difficulties in service provision remain relevant today for inner city and rural general practice throughout the UK
  5. The report is an iconic Scottish document which Scottish Council and North of Scotland faculty wish to celebrate and share with UK colleagues.
  6. No previous annual conferences have had a historical theme.
  7. The RCGP annual conference would become the centre piece of our year of Dewar celebrations and meetings in 2012
  8. This is a unique opportunity to demonstrate the value of historical analysis and reflection within RCGP. The detailed general practice history described in1912 by Dewar pre-dates the RCGP foundation documents of 1952 by 40 years.
  9. Understand our history can help plan our future in general practice. Associates in training have no opportunity in their curriculum to understand this important point.
  10. Rural health is a core area within WONCA and Dewar has an international relevance for international delegates as the world’s first analysis of rural health provision.

Potential conference titles for RCGP 2012 in Glasgow

  1. Reflecting on our history, planning for our future
  2. The value of history in delivering our future
  3. The value of our history in planning our future
  4. What can our history tell us about our future?
  5. In at the deep end with remote and rural health care
  6. What can we learn from the creative tension of history in health care planning?

Key Note Address at Initial Plenary Session by RCGP Scottish Council Chair:

“The Dewar Report of 1912 : What did he say then what does it mean to General Practice 100 years later?”

Workshop Themes for Parallel Sessions:

After the plenary by Scottish Council Chair:

The sessions titled as suggested below in the main complete programme to include the Dewar sub title .However , in the condensed programmes there would only be space for the main title and a colour coding stream for Dewar theme.
The modern speakers at the sessions would be given the Dewar quote to consider in advance.
Each workshop chaired by a member of the RCGP Scotland Centenary Group who provides a 5 minute historical context at the beginning of session and a 5 minute summary at the end of workshop:

The modern speakers are encouraged to reflect briefly on the current dilemmas, policy or research on this 100year theme but not give a detailed historical analysis!

Education:

“We are therefore of the opinion that the general efficacy of the existing medical service is impaired: (6) by lack of facilities for holidays or postgraduate instruction.”

Community Hospitals

“That the existing general hospital provision is quite inadequate, even if available in every case to the full extent of its capacity. That there is an urgent need of further provision; that such provision should be mainly in the form of cottage hospitals.”

Commissioning

“That any scheme proposed for improvement of hospital service the expediency of subsidising existing hospitals on definite conditions should be favourably considered.”

Child Health

“That there is a danger of physical deterioration from defective dieting, and more markedly in the infant and juvenile population.”

Medicalisation of Society and the Pharmaceutical Industry

“The brisk trade in patient medicines which has developed in recent years, and more particularly in the case of quack medicine of American manufacture. The Americans are more expert advertisers that the British.”

Telehealth

“There is abundant evidence to show that literal extension of telephone communication in connection with the medical service would be a great public boon.”

Health Inequalities in Inner City and Rural Populations

“That an account of the sparseness of the population in some districts, and its irregular distribution in others, the configuration of the country, and the climatic conditions, medical attendance is uncertain for the people, exceptionally onerous or even hazardous for the doctor, and generally inadequate.”

Changing Demographics of Professionals & Patients

“We are therefore of the opinion that the general efficacy of the existing medical service is impaired:

(b) by inability to provide for old age and infirmity.”

Mental Health Services in the Community

“The maintenance of pauper lunatics, therefore constitutes a serious burden upon rates, and especially in the poorest localities, where mental illness most prevails. There is evidence that generally remuneration for medical service to pauper lunatics boarded out among the population, is not commensurate with the responsible character of the work.”

Global Warming and Impact on Illness and Service Provision

“There are many days in the year that you cannot get a doctor owing to the ‘weather’.”

Informatics

Governments respond to data or lack of it from General Practice

“The existing medical attendance in the Highlands & Islands is inadequate. The most conclusive evidence on this point is to be found in the statistics of uncertified deaths. Amounting to 47.5% of the total. By way of contrast ……. Uncertified deaths in the whole of Scotland during the past 5 years is about 2%

Practice Nursing and Health Promotion

“The total number of nurses is quite inadequate, that while tending generally to alleviate suffering ………efficient nursing is urgently required in connection with:

1. The birth and infancy of children
2. The ‘following up’ and treatment of disease and defects in children as disclosed by school medical inspection
3. Promoting among the people a knowledge of personal and household hygiene, dietary, etc
4. The earlier detection of illness

Immunisation Policies

“It may be added that in many localities the committee found evidence of the rapidly increasing number of conscientious objectors to vaccination.”

Early Careers in General Practice post MRCGP, Career start schemes and Fellowships

“Young men recently out of college who make the appointment merely as a stepping stone to something better, remain only a year or two – not long enough to become sufficiently acquainted with the idiosyncrasies of the people, or the diseases that families inherit or are liable to.”

Women in General Practice

“You think a woman on average would be perfectly willing to undertake an emergency just as much as a man? Yes, an average woman doctor. Of course, if she was young and inexperienced she would be timid, just as a young man would be? – yes, I don’t think sex matters there.”

The Sick Doctor

“Older men, who after perhaps a chequered career, fall back on such places as a last resort of harbour of refuge. The most hopeful outlook before him is to die in harness, in case he dies of starvation when old age and decrepitude render him unable to continue work.”

The scope of General Medical Practice and the Training Curriculum

“The daily routine of a doctors work away, and indeed generally does, includes patients belonging to these different categories – medical, surgical and obstetric – and the fact that the doctor has to face the possibility at any moment of having to conduct the most serious and critical operation in surgery or midwifery implies the desirability of establishing a system of medical service of even a higher degree of competence than ordinarily obtains within reach of specialised skill and consultation.”

The Role of the Pharmacist in General Practice and Dispensing Doctors

“There is some evidence by druggists to indicate that the dispensing of drugs by doctors is regarded as more or less an encroachment on the druggist’s proper sphere; but, on the other hand, it was admitted that so called ‘counter prescribing’ and advice by druggists were not uncommon. Most of the medical witnesses expressed their preference for having their prescriptions dispensed by a properly qualified druggist.”

Maternity Services and General Practice

“In almost no locality, however, is there any definite understanding between trained nurses, midwives, unskilled persons and local doctor. There is, in a word, no systematic relation between doctor and maternity services. This is true with very few exceptions.”

Alternative therapies

‘It is in such a field of ignorant faith that the “skilly”
woman can practise all her arts at will, and with greatest danger where she is most in demand’

Continuity of care

‘In consequence of these unfavourable conditions there is in some districts a constant change of doctors………such frequent changes cannot but affect adversely the efficiency of the medical service in these localities.’

Managed clinical networks/ primary secondary care interface

‘There should be provision for assistance …….. where professional discussion and assistance are desirable.’

Mutual support in General Practice

‘there ought to be much more provision for medical and surgical consultations between local doctors.’

Complexity

‘It is not desirable to multiply authorities without necessity’

Conference Planning:

The topics which could be considered under a Dewar stream of historical reflection against current practice could be advertised in the call for papers and narrowed down to a smaller grouping depending upon response.

Conference papers could include a copy of the historical report or it could be made available for download from the conference website.

Dr James Douglas, Dr Peter Grant,
RCGP North of Scotland Faculty Board
Dewar Celebration Group 2012

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