Community general practitioners.

Commemorating a giant figure whose memory is still fresh to many is a heavy responsibility. Pat Byrne was a plebeian and rejoiced in the plebs' victory represented by the introduction of the National Health Service in 1948. In 30 years of practice in Milnethorpe, a market town and former seaport of Westmore? land, Pat developed the ideal of personal, continuing primary care of the highest clinical quality then possible. He was able to look after his patients as he would have wished himself, or his own family, to be looked after. In 1970 he became the first professor of general practice in England, in the utterly different circumstances of central Manchester. He did as much as any general practitioner, and more than most, to apply his Milnethorpe ideal to the reality of an industrial city. Though he went on to solve other problems successfully, in this particular task he was probably no more and no less successful than all the others who have broken their hearts trying to get enough clinical enthusiasm into urban industrial practice for it to achieve active, independent, un subsidised growth. He did not, and could not, transfer Milne? thorpe to Darbishire House health centre. If giants have failed to apply the rural and market town model of good general practice to urban industrial settings ordinary men and women are unlikely ever to do so. For too long we seem to have assumed that bad work in bad places can, by mighty acts of will, be changed into the good work of good places without any accompanying changes of structure or circumstance. We have attributed perfunctory care to perfunctory men instead of recognising that both are the consequence of intolerable circumstances that can and should be changed.