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Health secretary faces GPs to discuss primary care

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7025.205 (Published 27 January 1996) Cite this as: BMJ 1996;312:205

Primary care in the NHS needs to provide a better service, provide a better place to work, and be better resourced, the health secretary, Mr Stephen Dorrell, said last week. Mr Dorrell was outlining his vision for the future of general practice at a meeting of the General Medical Services Committee (GMSC).

He told the committee: “I do recognise that there is a sense that general practice has become the sink where every other activity is unloaded that cannot find a home elsewhere within the health service.” He went on to list the weaknesses of the existing structure of general practice, saying that for him the key weakness was the gap between the best and the worst, which he said was simply too great. “We have to confine that variation within acceptable limits.”

Mr Dorrell spoke of a clear role for developing primary health care as an important element of the emergency services. He added: “If we are talking about shifting work to general practice, that might mean general practitioners delivering more emergency care in hospital premises as well as surgeries. I am not saying that in future general practice will have a large element of hospital based practice. But where a general practitioner is interested, then I am interested.”

But his accompanying assurance that “growth of service in primary care will be matched by growth of resources,” was met with scepticism by the GMSC to the extent that during a discussion on morale among general practitioners Mr Dorrell countered: “Now you are making my morale low.”

Committee members raised several concerns during the meeting with Mr Dorrell, notably on the problems associated with treating people with mental illness under the care in the community policy; recruitment difficulties; increased workloads; morale among general practitioners; and current problems in attracting and retaining women doctors.

On the subject of recruitment Mr Dorrell admitted that he had received reports of advertised posts for which no one had applied. He said: “Where you cannot recruit people on the conventional independent contractor model then part of the solution is probably to have salaried contractors.”

Earlier this month Mr Dorrell announced that the government will review primary care services in Britain.—CLAUDIA COURT, BMJ

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