Supporting diversity in primary careBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7096.1706 (Published 14 June 1997) Cite this as: BMJ 1997;314:1706
If autonomy improves general practitioners' morale, nobody has a long term interest in taking it away
- David Jewell, Senior lecturer in general practicea
- a Department of Social Medicine, University of Bristol, Bristol BS8 2PR
The accumulating evidence clearly shows that general practitioners are able to perform a wide variety of clinical activities effectively. Recent examples include success in managing asthma1 and diabetes,2 which can be set alongside earlier evidence in areas such as managing hypertension and community obstetrics.3 Primary care's proved effectiveness and ease of access are a powerful combination, and planners and health authorities are now looking for new ways to transfer work from secondary to primary care to everyone's advantage. Examples of work that is initiated in secondary care but which is being shifted to primary care include routine follow up for breast cancer4 and earlier discharge from hospital after day surgery.5 However, picking out such examples obscures the true picture of a richly varied and rapidly changing landscape. For instance, a colleague was recently asked to discuss transferring responsibility for routine examination of newborn infants in his area from specialist paediatricians to general practice (G Young, personal communication), and in my own area general practitioners have been asked to take on preoperative counselling for vasectomy.
General practitioners' willingness to take on more clinical activity stems from a desire to provide better care for patients and a more rewarding professional life for themselves, but it creates an unstable primary care environment. Secondary care providers and policy makers quickly spot the opportunity to shift work …