John Gillies

THORACOLUMBAR SPLANCHNICECTOMY AND SYMPATHECTOMY

A method of combined analgesia, vasoconstrictor paralysis and narcosis has been devised, to provide an ischæmic field and adequate relaxation, with safeguards against disturbances of circulatory and respiratory dynamics. The reduction in operating time and the complete insignificance of any loss of blood are advantages which contribute to the undoubted value of the method and the satisfactory results achieved. Frequently, the hypotension induced has been extreme, possibly unnecessarily so. As the series proceeded equally satisfactory results have been obtained with systolic pressures of about 70 mm. Hg, which may be regarded as the optimal level.

Distilling the essence of general practice: a learning journey in progress

Over the past 5 years, general practice in the UK has undergone major change. Starting with the introduction of the new GMS contract in 2004, it has continued apace with the establishment of Postgraduate Medical Education Training Board, a GP training curriculum, and nMRCGP. The NHS is developing very differently in the four countries of the UK. Regulation of the profession is under review, and a system of relicensing, recertification, and revalidation is being introduced. The Essence project, initiated by RCGP Scotland in conjunction with International Futures Forum 4 years ago is a constructive response to these changes. It has included learning journeys, a discussion day for GPs, and commissioned short pieces of 100 words from GPs and patients. From an analysis of these, some characteristics of the essence of general practice have been defined. These include key roles and core personal qualities for GPs. It is argued that general practice has important and unique advantages - trust, coordination, continuity, flexibility, universal coverage, and leadership - which mean that it should continue to be central to the development of primary care throughout the UK.

Time to care: tackling health inequalities through primary care

Health inequalities are systematic, socially produced and unfair: systematic because the differences in health outcomes are not randomly distributed but rather show a consistent pattern across the socioeconomic spectrum; socially produced because no Law of Nature decrees that the poor should endure greater ill health and premature mortality than the rich, and unfair because they are maintained by unjust social arrangements—arrangements which mean, for instance, that the chances of survival for many children are determined by the socio-economic position into which they are born. 1

Improving together: a new quality framework for GP clusters in Scotland

In her address to the Royal College of General Practitioners (RCGP) Annual Conference in Glasgow in October 2015, the Scottish Government’s Cabinet Secretary for Health and Wellbeing, Ms Shona Robison, announced her intention to dismantle the Quality and Outcomes Framework (QOF) — the pay-for-performance scheme introduced into the UK general practice contract in 2004 — and replace it as part of a new Scottish General Medical Services (GMS) contract. This contract, of which elements will be introduced through 2017 and 2018, will contain an obligation for practices to participate, as part of a ‘GP cluster’, in a new framework for quality improvement more suited to the emerging models of care in Scotland that will be required to meet the challenges facing modern health care.1 This move away from a single UK contract for GPs denotes further divergence in the NHS across the four nations.2,3 A new contract for GPs in Scotland is a historic event. This route to a Scottish contract for GPs began in 2012, after UK negotiations stalled, allowing a separate agreement between the Scottish Government and the Scottish General Practitioners’ Committee. This introduced the first discernible change in the approach to the GMS contract across the four UK nations. Further catalysts to the development of this contract have been the statutory introduction of health and social care integration in Scotland4 and a commitment from both the Scottish Government and the BMA in Scotland to work together to identify solutions to shared challenges. The healthcare system is changing in response to the demands placed upon it and must continue to do so to preserve universal access and further improve health and wellbeing within our communities. The National Clinical Strategy 5 signals the intent to transform the …

Dr Pat Manson and the way forward

Dr Pat Manson, the GP, was compassionate, caring, conscientious. As a father, he was committed, involved, proud. And then he took his own life. Why? The question that will never be answered, by his family or by his colleagues, us among them. In a piece he wrote 3 years ago, he acknowledged both his ‘tendency to obsessionalism’ and his occasional dark thoughts. He quoted a trainer colleague he greatly admired, Dr Malcolm Lindsay, talking about being a ‘good enough GP’. But being ‘good enough’ was not good enough for Pat. He set very exacting standards for himself and, over the last few months of his life, he had been struggling to reconcile the sort of available, family GP he wanted to be (the sort his father had been before him) with …

The magic bullet and other medical stories

![][1] Eds Stefan Slater, Robin Downie, Giles Gordon, Richard Smith Royal College of Physicians and Surgeons of Glasgow, £6, pp 101 ISBN 0 953 5833 09 Books available from the college Rating: ![Graphic][2] ![Graphic][3] ![Graphic][4] In medicine today, culture is “in,” culture is sexy. The British Journal of General Practice includes new poetry and articles on doctors in literature. Last years spring symposium of the Royal College of General Practitioners was on the theme of “The Art and Science of General Practice.” Narrative based medicine, which suggests (to me anyway) the … [1]: /embed/graphic-1.gif [2]: /embed/inline-graphic-1.gif [3]: /embed/inline-graphic-2.gif [4]: /embed/inline-graphic-3.gif

Questionnaire severity measures for depression

The paper by Leydon et al illustrates the continuing tension between two important elements of generalism: the biotechnical (use of the measures PHQ9 or HAD-D introduced as part of QOF) that the authors refer to as ‘hard technology’, and the biographical (a narrative-based approach to diagnosis, based on the patients context) referred to as ‘soft technology’. Concern about the current …

'Learning together': Sharing international experience on new models of primary care

Recent editorials in the SJPHC have highlighted some of the challenges facing general practice (GP) and primary care across Europe (such as multimorbidity and widening health inequalities) [1], as well as possible solutions (such as task shifting and strengthening primary care research) [2–4]. Such proposed solutions have been called ‘New Models of Primary Care’ [5] and include better integration between primary care and secondary care and between health care and social care; development of more multidisciplinary teams (MDTs); and GP practices working collaboratively in clusters. This represents a major cultural shift. This editorial presents the Edinburgh Consensus Statement on new models of primary care (Box), distilled from discussions at an international workshop hosted in Edinburgh, Scotland on 17 May 2017 by the Scottish School of Primary Care (SSPC). External speakers included academic and primary care leaders from Australia, Canada, Denmark, Finland, the Netherlands, Norway and Wales. There were remarkable similarities between countries not only on the common challenges faced (ageing populations, health inequalities, multimorbidity and escalating healthcare costs) but also in the proposed solutions that are currently being enacted or suggested by Governments and healthcare systems.

Compassion, medical humanities and medical education

Abstract Compassion is central to person centred clinical care. Medical Humanities have developed both as an academic discipline and as a resource for education over the past 30 years. The article will discuss what compassion is in a clinical context, and explore whether compassionate clinical practice can be enhanced by using the humanities in medical education in primary care.

The Journal of Comorbidity affiliates with the Scottish School of Primary Care

The Journal of Comorbidity is pleased to announce a new partnership with the Scottish School of Primary Care (SSPC). The SSPC is a virtual school comprising all Scottish academic departments with significant primary care research output. This currently includes the Universities of Aberdeen, Dundee, Edinburgh, Glasgow, Stirling, and St. Andrew’s. This is the second important partnership that the journal has formed to strengthen ties with professional primary care networks with an interest in comorbidity and multimorbidity research. It is anticipated that this new collaboration will increase the journal’s reach and help cultivate research, discussion, and knowledge about comorbidity and multimorbidity. The Scottish School of Primary Care Since its inception in 2000, the SSPC has established a reputation for research excellence, attracting new research funding to Scottish universities. The school aims to support the development of a sustainable, equitable, high-quality primary care service that meets the needs of the people of Scotland. Working towards this vision, the SSPC’s current strategic objectives are to: Inform key stakeholders by collating relevant available national and international evidence, as well as actively contributing to the growing evidence base Support the continuing growth of academic primary care in Scotland Promote Scottish academic primary care internationally. Journal of Comorbidity 2017;7(1):112–113