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Making Sense of the Red Book is primarily a guide to what the words in the Statement of Fees and Allowances mean here and now - a sort of dictionary. Larger dictionaries tell you when words were first used, what their origins are, how meanings have changed and how they vary between places. However, the dictionary analogy does not completely explain what this book can do to help GPs, practice staff and health authority managers.
The Red Book is a musical score rather than just a collection of words. It even had a composer (a civil servant, Bill Roberts) although it is of considerable significance that it is generally rewritten by two sides: the five General Medical Services Committee negotiators and their advisers, and the government side, usually civil servants, with a Minister in the background, sometimes becoming involved directly. The Red Book is divided into songs or movements too. The themes of the Red Book are echoes of early contracts - West Side Story based on Romeo and Juliet, perhaps.
Written in 1966 the first Red Book was thirty five pages in length; the current Statement is ten times longer. However, even the first Statement is a complex document that reflects a much longer history.
In this chapter, each of the main stages in the evolution of the Red Book is reviewed in context. This context needs to embrace not only the immediate background of discussions - frequently arguments - between doctors and the government, but the wider health, social, economic and political context. Throughout, the focus is on GPs rather than practices, reflecting the fact that the contract and the negotiations are between GPs and the State.
The GP contracts of 1948, 1966 and 1990 all build on earlier arrangements while introducing new elements. Contractual developments do not necessarily go hand in hand with changes in the kind of medicine being practised. There is obviously a significant move forward in health care between AJ Cronin's novel about general practice in a Welsh mining area in the 1920s and Julian Tudor Hart in the 50s and 60s, though there are also possibly surprising continuities in practice based research, for instance.1,2 In contractual terms, the differences may be less. The contrasts are striking in the description of Harry Roberts' practice in East London between the wars and David Widgery's in the 1980s and 1990s.3,4 However, in contractual terms many elements remained the same and indeed go back to before the formal beginnings of state funded general practice - the 1911 National Insurance Act.
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| Book Title: Making Sense of The Red Book | ||