Rapid Responses to:

HEAD TO HEAD: Stewart Kay Will polyclinics deliver real benefits for patients? No BMJ 2008; 336: 1165 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Most medical work is done in secondary care, not primary care

Paul Miller   (23 May 2008)

An article to be supported

Patrick J Boyd   (27 May 2008)

Most medical work is done in secondary care, not primary care 23 May 2008
Paul Miller, Consultant Psychiatrist Northlands CHC, Sheffield, S5 8BE Send response to journal: Re: Most medical work is done in secondary care, not primary care	It is most unfortunate that the author states "As 80-90% of medical encounters happen in general practice" since this is simply untrue and would be utterly misleading even if it were true, since it compares GP appointments of relatively brief average duration with hospital activity which includes operations, lengthy admissions and multiple consultations and examinations, all counting as a single "episode". Counting consultants, junior doctors and Staff & Asociate Specialist (SASC) doctors, there are approximately 2.4 hospital doctors for each GP. The 2006-07 GP workload survey found the average GP worked 38.2 hours each week, with full timers averaging 44.4. These are fewer hours than the average paid programmed activities (hours) of consultants, who almost all work compulsory nights and weekends which are not reflected in programmed activity data. Juniors and SASC doctors also work long hours, so it is a fact that there are many more hospital doctors than GPs, and they probably work longer average hours. This makes it self evident that the majority of doctor-patient work takes place in secondary care. NHS data supports this. It showed that in 2006 GPs carried out 180 million of the 290 million consultations in general practice. In 2005-06, there were 50 million out-patient attendances and 14.5 million in-patient admissions, half of which had an operation. In 2006-07 there were 19 million A&E attendances and in 2002-03 there were 4.6 million day care attendances. Of course, each of these numbers reflect different activities, and while some may be brief, some will reflect transplants, weeks in ITU or months on a psychiatric ward. Good general practice and good general practitioners are very important to patients, and to secondary care. But we must stop repeating the myth quoted above, and remember that in the UK NHS, many more doctors work in secondary care than in primary care, and most medical work for patients takes place in secondary care. Paul Miller Competing interests: Ex chairman of BMA consultants committee 2002-2006
An article to be supported 27 May 2008
Patrick J Boyd, retired SW19 Send response to journal: Re: An article to be supported	Stewart Kay's article is an excellent summary of the arguments against the blanket introduction of polyclinics but fails to fully emphasise the spurious argument that this is supported by a majority of patients or potential patients. The number of individuals who responded to the critical question in Consulting the Capital is significantly less than the total of under 4500 and yet this is an initiative that is being introduced on the basis of popular support. It seems likely that management of the NHS will be yet another area where Gordon Brown has miscalculated and will backfire when election time comes. Competing interests: None declared