The University of Bristol
The University of Bristol
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The medical faculty of the University of Bristol was slow to accept that general practice has a role in teaching medical students and was the last of the pre-2000 medical schools in the UK to create an academic undergraduate post occupied by a general practitioner. The story behind this development is interesting and illustrates the way that tradition can be challenged and eventually altered.
In the early 1960s, Bristol's professor of public health and medical officer of health, Robert Wofinden, created a name for himself with the development of health centres. He saw this as a way of bringing together general practitioners, nurses, midwives and health visitors to improve the health of patients in various parts of the city. At the same time Michael Lennard, a relatively recent Bristol graduate, was working in general practice in Hartcliffe, a new estate in the south of the city, and was keen to introduce medical students to general practice. In 1963 Sandy Macara (later president of the BMA) was appointed lecturer within the small public health department and given the responsibility for running a four-week general practice clerkship. In 1965 the south-west faculty of the College of General Practitioners sent a memorandum of evidence to the medical curriculum review committee of the university stating ‘we strongly urge the setting up of a department of general practice as a logical step in the development of undergraduate medical education’.
The general practice input within the public health teaching enthused the medical students and the medical student society asked Dr Macara to conduct a survey of medical student opinion about the need to have dedicated time in general practice. The results were very positive and were presented to the medical faculty only to be resisted with comments from many of the senior professors that ‘we can't have general practitioners teaching our students heresies'. Eventually, in the mid-1970s, with support from child health and the geriatricians, a new six-week (p.38) course for the final year was agreed, called ‘medicine in the community’. This course was intended to ‘introduce students to medicine in the community’, not to teach as such! Two weeks of this was to take place in practices throughout the region with some time spent in city practices. Doctors who took the students in their practices were rewarded with a university title of ‘teacher in general practice’ enabling them to have access to the medical library and sports facilities.
Postgraduate teaching of general practice was reasonably well financed and supported. Michael Lennard was appointed as regional adviser in general practice in the early 1970s for the whole of the south-west and this job was subdivided a few years later. The university recognised Michael Lennard as postgraduate adviser in general practice for Gloucester, Avon and Somerset, and Denis Pereira Gray as postgraduate adviser for Devon and Cornwall in 1975. The course organisers who had been appointed in 1975 were called ‘recognised teachers in general practice’ by the university in the same year. They ran the weekly half-day courses for aspiring general practitioners and organised the new vocational training courses throughout the region. These courses in the south-west were very popular and Exeter, in particular, developed considerable expertise in educational method and created a thriving postgraduate department of general practice under the leadership of Pereira Gray.
Having a well-organised postgraduate practice network was of great help in organising student placements throughout the region. However the faculty remained resistant to developing an academic presence in the medical school and missed at least one opportunity of obtaining central government funding for such a development. John Howie was appointed as the RCGP Jephcott visiting professor in 1979–1980 and his report to the university outlined the way to develop an independent department of general practice. A university working party report on how this new department could be developed had its proposals rejected and again the need for such a department was questioned.
One key development that eventually forced a change was the decision of general practitioners and consultants within the postgraduate education department in the south-west in 1985 to set up a charitable trust to raise money, primarily from general practices in the south-west, to support departments of general practice in the Universities of Bristol and Exeter. The Trust's target was £250,000 as a pump priming effort to stimulate major authorities in the region to fund the two departments – to start a department in Bristol and to permanently secure the one in Exeter. This had the almost immediate effect of obtaining funds from the south-west region and the university was able to report in November (p.39) 1985 that ‘the way is now clear for the appointment of a full-time consultant senior lecturer in general practice for a period of five years and a three year appointment of a consultant senior lecturer once the first appointment has been made and the successful candidate is in post’.
In 1986 Michael Whitfield was appointed full-time senior lecturer in general practice within the department of public health medicine, with the university funding five sessions and a full-time secretary. David Jewell was appointed a year later as senior lecturer. New funding brought in Chris Watkins as a part-time senior lecturer, and Richard Baker (who later moved to a chair in Leicester) and Lindsay Smith as part-time research fellows. A full-time chair was eventually funded by the south-west RHA and the university appointed Debbie Sharp to the position in 1994.
The timing of this appointment coincided with the first edition of the 1993 GMC publication Tomorrow's Doctors and with a radical rethink of the medical undergraduate curriculum that resulted in a new emphasis on communication and consultation skills, both of which were very much the domain of general practice. Very quickly, under Debbie Sharp's leadership, general practice was to be found in each of the five years of the undergraduate curriculum. This was helped a great deal by the support of the then FHSA who believed strongly in the student presence in practices helping to raise standards.
The other major fortuitous activity was the development of the NHS R&D initiative which in the mid-1990s had several commissioned calls for research that spoke strongly to the academic general practice agenda and skill base. This, together with further funds to appoint two lecturers in general practice, marked the beginning of an extremely successful research unit, initially as part of the then department of social medicine and later as an autonomous division in the medical school. As the grants were obtained more staff were appointed, a sufficient critical mass developed, high quality papers began to be published and a virtuous circle began. In addition there was early success in obtaining research training fellowships for both clinical and non-clinical primary care researchers and Bristol began to develop a name for itself in academic general practice circles as a good place to be.
Attracting high quality staff like Chris Salisbury and Tom Fahey, both of whom went on to gain chairs, ensured that Bristol became a force to be reckoned with on the UK academic general practice scene. By 2000 the medical school had clearly recognised the value of academic general practice, appointing Debbie Sharp as head of the school of medicine.