Introduction - an analysis of the different aspects of bureaucracy and regulation which influence decision making in general practice.

1. Poppets and Parcels - healthcare systems are not designed to meet the needs of everyone. This chapter is about a fundamental but undocumented component of general practice - the 'holding work' required for patients whose problems can't be solved in the usual ways, the ones for whom there isn't a simple answer.


2. Waiting to Connect - In this chapter, the stories are about flow - the flow of patients through a turbulent, over-stretched system in which access and response are often controlled by algorithm.


3. Taking Liberties -this chapter examines the role of GPs as agents of social control in the restriction of civil liberties - in the context of the mental health act and of safeguarding.


4. Guidelines, Tramlines, Mindlines -how guidelines are developed and the difficulties of applying them in the messy world of general practice.


5. The Elephant in the Room -the stories in this chapter are about biography and biology; about medical categorisation and its effects and shortcomings.


6. The Bureaucracy of Death - In the realm of death, protocol -which has become the bedrock of clinical practice- is less useful, because the right decisions and the right timing are so individual and nuanced. These stories are about death and bureaucracy.

Conclusion and Afterword
A Labour of Love -a few stories to end, of healthcare enacted with love

'This book is not about nostalgia, and we are not suggesting a return to a 'better' time. It is not that as practising GPs, Jens and I object to being embedded within and accountable to the systems we are part of. But we do want to consider how, and with what, the gap left by the archetypal GP has been filled.'

In Fighting for the Soul of General Practice, Rupal Shah and Jens Foell, two practising GPs describe the reality of working within a failing and highly bureaucratic system. Drawing on years of experience treating a wide range of patients from all backgrounds, they show what is lost when regulation overrules relationships, standard practice eliminates discretion, and algorithms displace personal attention. While acknowledging that bureaucracy is inevitable and important, they argue for an approach to medicine that is about creating meaning for doctor and patient and that privileges connection, attention, and care within each encounter.

Rupal Shah is a GP in Inner City London and works as an Associate Dean for NHS England. As well as her many academic publications, she is a co-author of 'Our Mothers Ourselves', a memoir of mothering.

Jens Foell is a practising GP and Academic, who is deliberately choosing to work in undifferentiated primary care rather than a specialist service. He has an interest in mental health, chronic pain and health policy and was also trained in rehabilitation and social medicine.