Can the history of primary care be used to inform its future? Developing an innovative approach to understand patient engagement with primary care services

Problem

The history of primary care in England is a neglected area of research and yet taking a historical approach can make an important contribution to our understanding of people’s behaviours and attitudes. There is currently very little data about people’s experiences and attitudes toward healthcare, illness, and treatment during the period 1940-1970. During this period healthcare changed radically with the arrival of the NHS making healthcare accessible and affordable. As this period is still within living memory, we have an opportunity to engage people with lived experience, to ensure their stories are preserved and used to inform research. To address this we have worked with patient and public collaborators and community groups to develop a novel methodology for collecting memories of everyday healthcare.

Approach

Archival research was undertaken at the Black Country Living Museum and the Walgreen Boots Alliance archive to identify historical materials relating to primary care. These include photographs of chemist shops (exterior and interior), advertisements, medical/pharmaceutical objects, and packaging (such as medicine bottles, commercial cough medicines). These images were presented to public contributors to test whether they help to stimulate memories. Discussions were held with contributors about how best to engage future participants with these materials.

Findings

The work has demonstrated that people with lived experience from the period are keen to engage and share their memories and experiences of healthcare. The archival images play an important role in prompting memory recall and work as a novel stimulus to prompt interesting discussions between people. Contributors in community groups frequently moved conversation from healthcare in the past into comparison with their recent experiences of healthcare in the present. Through this they raised issues related to (1) aging (2) difficulties navigating a healthcare system that has changed dramatically in their lifetime. (3) their views about healthcare professionals’ behaviour toward older people.

Consequences

The work has led to the development of a ‘memory pack’ which will be used in a future research project to elicit and collect memories of everyday healthcare from 1940-1969.

The findings from this development work suggest that history can play a role in contemporary primary care research by contributing to our understanding of patient attitudes and behaviour. Particularly in relation to engagement with primary care services, self-management of minor illness and healthcare seeking behaviours.

Such learnings which have potential to be fed back into service delivery to change communication practice.