Utopian Pipedream: Community Medicine

We have lots of GP practices in the UK. I don’t find them particularly inspiring places to visit as a medical student, let alone as a patient!
All too often, our health centres are hidden behind dreary NHS logos, contained within a dated bungalow design or a misshapen renovation attempt. Even if you are lucky enough to be part of a purpose built and swanky number, how can you escape the smell?! Disinfectant, industrial fabrics and hand sanitiser wafts through the air in noxious waves, wrinkling the noses of the young and crinkling the noses of the wrinkled.
This is a vast exaggeration – but is based upon an image I hold of a normal community care practice.

In my utopian scenario, a GP practice wouldn’t feel like a place to be avoided. I would prefer to see a positive environment based on education and cooperation, the centre of a community, a place where an appointment isn’t accompanied by an ailment.
The atmosphere isn’t stuffy or suffocating and the environment doesn’t betray a hint of hostility. Rather, it smells like hot coffee, sounds like the hustle and bustle of community and tastes of freshly prepared food from an in-house café (Locally sourced to encourage an economic flow, of course).
My dream is that the flux of people coming and going won’t be labelled as sick and passive. I’d like to see it be more a health-hub, where people can come happily, if they’re sick or not. Swinging a pendulum from the normal ‘morbidity and mortality’ of healthcare to the other side – the sexed up, glamourised dream of ‘self fulfilment, development and happiness’.
Patients wouldn’t feel rushed during the consultation (preferably because in the long term, disease would be managed), and both doctor and patient invest into their relationship. Diet and lifestyle prescription is a priority focus in a consultation. The healthcare team is multidisciplinary, incorporating doctors, nurses, plus a broader spectrum of health coaches – dealing with nutrition, stress management and exercise.

Why do I see my ideal GP practice as so drastically different to the current system?
I am not forgetting that GPs have a huge workload and funding is a worsening drought – but what we’re doing isn’t working. Our current model of identifying disease after it has struck isn’t a successful way to treat our increasingly ageing population. In the UK, the King’s Fund estimates we have 15 million people living with a chronic disease, with the numbers only set to increase.
Community care is a great idea; but our GP practices don’t have enough community. If we can truly engage with a community and make health as normal as going grocery shopping or visiting the pub, I hope that change can be made on a population level.
Therefore, the community is an essential part of my health-hub concept. My ideal GP practice isn’t just an adjunct to society – it embraces and integrates into society. Consumables such as food and drink are but one way to make an area attractive. What about recreation rooms or art galleries, plastic spaces accessible to local traders to sell wares? Linking with a primary school to provide care, immunisations and to give the future generations an early introduction into health ownership. Creating a place that is so intertwined with normal lives, the public proudly adopt it as their own.
Since I’m on an imaginative stroll, how about we directly partner a gym to the practice?
I’d structure the day’s lists to allow my employees to work out between 1pm and 2pm, and give them free access to the facilities. The public are welcome to become members, and patients in the practice are incentivised with a discounted rate.
Further incentives are multiple; systems where the more a patient goes to the gym, the less they pay. Family based savings. Workplace workouts. The possibilities are endless.

Ah, dreams. The stuff progress is made from.
I think an approach like this would reform primary health care. By bringing care closer to preventative medicine approaches and the community, I hope to reduce chronic disease by promoting health ownership and positive lifestyles. I am certainly not neglecting emergency medicine and paramedics – they have their own separate necessary roles in providing a complete service of care. They do a good job and save many lives.
My dream may be unrealistic in our current social, medical and economic climate. However, change is always on the horizon, and certain pressures such as economic uncertainty continue to squeeze the NHS.
As we learned in A Level Biology, environmental pressures drive selection and adaptation – perhaps it’s time for the birth of a new species!


Ownership of health is something that interests me. Check out A Health Fund for more!

I welcome your feedback – any aspect of what I’ve written. Don’t extinguish the pipe dream too vigorously, please.


  1. Hi Rory,
    This is not such a pipedream; in a low income area of Boston there is a Charter school called Codman Academy (http://www.codmanacademy.org). This school is within a health centre (http://www.codman.org), linked to a fitness centre for mums to use whilst the children are at school and, to a healthy, low-cost supermarket in the area (http://dailytable.org/store-location/dorchester/). They are expanding to accommodate for more children and the new buildings encompass city gardens. The ethos of the founding teachers is to invest in the community and provide a safe space for children to grow and learn so that in turn, they can invest in their community at a later stage.
    Let me know what you think!

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