Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
The grass is greener
- Peter S L Barling (18 November 2005)
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A return to quackery
- John Hopkins (22 November 2005)
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Doing Better, feeling worse, heading for the rocks
- David P Kernick (22 November 2005)
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Re: A return to quackery
- Onisillos Sekkides (22 November 2005)
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Re: Re: A return to quackery
- John Hopkins (23 November 2005)
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Competition in general practice could force education out
- Roger H Jones (30 November 2005)
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Are we about to lose the values of General Practice?
- THEYVANAI CHETTIAR (2 December 2005)
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Peter S L Barling, GP Oswestry,SY107HR
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Dear editor, I have worked for 10 years in Canadian general practice and just over 20 years in UK general practice. The Canadian system was competitive and market orientated, while we are familiar with the UK model. I found many subtle factors in a competitive system which could be described at the very least as unattractive. There always seems to be some journal paper that supports over investigation,excess surgery and over medicalisation which results in increasing neurosis in patients and establishes a self perpetuating system of reliance.We should realise that our system may need tinkering, but let's not throw the baby out with the bath water Peter Barling Competing interests: None declared |
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John Hopkins, GP DL10 6SQ
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Dear Editor, With each new policy announcement the pattern becomes clearer; the Department of Health wants to break the monopoly of doctors as providers of medical services in this country. The training of science graduates as medical care practitioners able to 'diagnose and treat' ; the emergence of surgical care practioners who will take over many of the tasks currently undertaken by surgeons in training, ( to the abundant fury of those young men and women who have spent their formative decade preparing for such work); the bizarre notion that 'medically trained' receptionists should undertake primary care triage; all of these measures speak of a Government intent on putting doctors firmly in their place. And this week we have the expansion of prescribing powers. Consultant nurses march proudly into television studios to explain how this will enable them to feel more satisfied at the end of the working day and pharmacists inform the BMJ rapid response page that they see no reason why they shouldnt be giving their customers methotrexate along with the cold remedies and chocolate. I wonder if, when the Secretary of State and her officials are congratulating themselves on dealing another blow to medical paternalism, any of them stops to consider the impact these changes will have on the public. Would any of them seriously wish to have an operation on themselves performed by a non-medically qualified surgeon, would they be willing to have their chest pain or unexplained weight loss diagnosed by a well meaning science graduate who has been 'on a course', would they allow a pharmacist to decide which of a range of potentially toxic drugs is best suited to their own medical condition. Of course they wouldnt, and neither should the public. Dr John Hopkins Competing interests: I am a doctor |
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David P Kernick, General Practitioner St Thomas Health Centre, Cowick, Street, Exeter EX4 1HJ
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A burgeoning succession of government reports, over 50,000 papers on health service research and the percent of the population who feel that they are in poor health continuing to rise, the NHS is broadly back to where it was in 1991. However, the theoretical discourse that drives this academic jamboree reaches back much further, driven by the perceived need to correct the inevitable market failures of the health care economy. Seduced by the misconception that what can be measure is important and that measurement means control, it conveniently overlooks the fact that the approaches of modern science on which it is based have failed to resolve social problems. Until recently, the dissonance between political-academic rhetoric and end user reality was corrected by manipulation of top-down directives by NHS “street bureaucrats”- the healthcare professionals and managers who operated in an environment of complexity and uncertainty. As a result, the system survived under the illusion of an NHS that was both “modern and dependable.” The NHS is now at a critical watershed. The chosen pathway focuses on the individual as the central unit of analysis with its emphasis on reductionism, utility maximisation and individual choice driven by competition. Reflecting the historic NHS fundamentals of trust, mutuality and reciprocity, the discarded alternative emphasises co-operation and the development of a conversational competence amongst stakeholders recognising the importance of health emerging from the relationships we have with each other. The latest rotation of the policy wheel will fragment the NHS in a way that is irreversible. Although there may be short term gain there will be long term pain. Competing interests: None declared |
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Onisillos Sekkides, Medical Editor London, NW1
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"Would they allow a pharmacist to decide which of a range of potentially toxic drugs is best suited to their own medical condition." I would, after all, isn't it reasonable to assume that a pharmacist might be better informed on these matters. In fact, I'd expect a pharmacist to know more than a doctor about drugs. In many "sciences allied to medicine" you are taught to ration the specialist knowledge you pass on to doctors. When I trained in medical microbiology, we were taught to limit the list of possible antibiotics in the lab report to the most common types. This was to prevent misuse of antibiotics by doctors. Competing interests: None declared |
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John Hopkins, GP DL10 6SQ
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I dont want to get into tit for tat responses but Sekkides makes the same mistake as the Department of Health in assuming that medicine consists of a series of toolkits that can be broken into smaller and smaller parts that any of a range of people can be trained up to use. Rather as though a Jumbo Jet can be flown by a small team each expert in one aspect of flying a jet. The person best qualified to make a judgement about drugs, particularly potentially toxic drugs, is the one who has spent many years observing in careful detail how they effect the patient and their illness. That person is the doctor and the time has come to stand up and say so. John Hopkins Competing interests: None declared |
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Roger H Jones, Head of Department of General Practice & Primary Care King's College London, SE11 6SP
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The excellent trio of articles examining the impact of the Government's planned market reforms on healthcare provision barely mention education and training, and the potential for damage to both in a 'contestable' healthcare environment. Around three-quarters of hospital- based medical education takes place outside our teaching hospitals, and around 15% of the undergraduate curriculum is delivered in general practice. It isn't difficult to see how easy it would be, with private providers attempting to cherry pick services and undercut tarrifs, for little attention to be paid to teaching, training and professional development. A number of studies have demonstrated the positive relationships between involvement in undergraduate teaching, postgraduate training and quality of care, staff morale and recruitment and retention. The London Implementation Zone Educational Incentives programme a decade ago showed that it was possible to attract and retain bright young general practitioners in the inner city by introducing an 'academic' component into their activities, and this linkage formed the basis for the introduction of Teaching Primary Care Trusts a few years later. At a time of Government commitment to a learning environment in the NHS, policy makers and commissioners will need to take care lest education and training fall through the cracks between de-constructed and privatised health services. Competing interests: None declared |
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THEYVANAI CHETTIAR, GP registrar 53 Borough Street, Castle Donington, DE74 2RX
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As a young GP registrar enthusiastically embarking on a career in General Practice, the thought of a more market based, open all hours supermarket style primary care system leaves me feeling much like the small green grocer of a decade ago. Could the values that I hold highly in General Practice survive such a transition? And if not, is there really a place for me within the medical profession in the UK? As I find myself working the hardest I've ever worked, and watch my senior colleagues work even harder - for the patients and their well being, I am left angered by Patricia Hewitt's misguided determination that Primary Care must undergo such a radical change. There is always going to be room for improvement in any service, but I strongly feel that these drastic changes, which will be irreversible once made, can only reduce the quality of care, not strengthen it. Will they really offer a cheaper service, more patient choice and increased GP satisfaction? Or, are we just bowing to the needs of our nation's capital? After ten years of training, I find myself in a job that gives me a true sense of satisfaction and purpose. A job that I can only say I love. But I have recently found myself feeling unappreciated and the skills of general practice undervalued by the Government. Perhaps emigration is the only option. Competing interests: None declared |
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