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EDITORIALS: Janet E McDonagh and Russell M Viner Lost in transition? Between paediatric and adult services BMJ 2006; 332: 435-436 [Full text]

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Primary care not mentioned (again)

john sharvill   (27 February 2006)

General Practice provides valuable continuity during transition

Eleanore A Simm, Michael Brown, Brian McKinstry   (3 March 2006)

Primary care not mentioned (again) 27 February 2006
john sharvill, Family Doctor Deal Ct14 7au Send response to journal: Re: Primary care not mentioned (again)	I sometimes feel on reading the BMJ that the editors forget that 90% of illness in managed entirely in primary care. Yes there are young people who need to transition through adolescence from children to adult services. Although I cannot quote figures a significant number of children will not need to be followed up in hospital services at all at the end of their growth. Most of those with diabetes and I suspect all of those with hypothyroidism should be discharged from hospial follow up. Yes there are those with complex renal, cardiac, malignant, joint and other disease processes that will need specialised input especially during the difficulties of adolescence but to have a leading article without mentioning the family doctor who often is the coordinator if not the provider of care seems remiss? Competing interests: Primary care doctor
General Practice provides valuable continuity during transition 3 March 2006
Eleanore A Simm, Medical Student CHS: General Practice Section, University of Edinburgh 20, W Richmond Street Edinburgh EH8 9DR, Michael Brown, Brian McKinstry Send response to journal: Re: General Practice provides valuable continuity during transition	Dear Sir, We were interested to read the editorial by McDonagh and Viner (1) and support the key elements of transitional care they advocate. However, one element that was not discussed is the role of the General Practitioner (GP) in the management of chronic illness during and following transition. GPs play a central role in care coordination post-transition and are well placed to help provide continuity of care. We conducted a small survey of carers of people with Profound and Multiple Learning Disabilities (PMLD) in Scotland. This revealed carers were significantly more dissatisfied by care on transition to adult services and failure of care coordination was a central factor in this. In addition a follow-on survey of GPs in Lothian found that 65 of the 100 who responded to the questionnaire felt they did not have adequate training to assess and treat people with PMLD and 63 felt that they would benefit from additional training. With an ever increasing number of GPs who have special interests in specific chronic diseases, the possibility of training GP specialists to help manage transition and beyond is an appealing one. We found an encouraging number of GPs (16 of those who replied) who would be interested in undergoing such specialist training. Yours faithfully Eleanore Simm, Medical Student, University of Edinburgh Michael Brown, Nurse Consultant, NHS Lothian Brian McKinstry, Senior Researcher, Community Health Sciences:GP Section University of Edinburgh (1)McDonagh JE, Viner RM. Lost in transition? Between paediatric and adult services. BMJ 2006; 332: 435-436 Competing interests: None declared