General practitioners in south Wales are unconvinced of their role in genetics services

EDITOR—Kumar and Gantley's work opens a necessary debate about the role of general practitioners in providing genetic services.1 Specialists suggest that many aspects of genetics services should be offered in primary care. This is argued on the basis of familiarity with families and their dynamics, access to a life long clinical record, in the NHS at least, and the provision of potentially continuous care. But there are large doubts about the capacity of general practice to shoulder this new work.2

Our early analysis of research work conducted with general practitioners in south Wales over the last six months of 1999 confirms the lack of detailed knowledge about genetics in general and cancer genetics in particular. More importantly perhaps, genetics does not seem to be considered a relevant priority compared with other pressures faced by general practitioners. The call of Watson et al for an increase in educational activity in this discipline may be misguided.3 We found that general practitioners were reluctant to undertake the detailed family histories required during consultations and to acquire the data and skills needed to explain risk to patients, although they acknowledged that this could guide the appropriateness of referrals to a newly established all-Wales cancer genetics service. However, their hesitancy was based entirely on the practical problems of matching time to demand. They simply could not perceive a generalist service oriented towards the need to satisfy the detailed exchange of information required in a genetic counselling exercise, and they rejected the idea that this could ever be assisted by computer assisted decision aids, given the current constraints.

The establishment of an all-Wales cancer genetics service earlier last year was generally welcomed, yet there was some unease about the requirement to adhere to referral guidelines to prevent the service being overwhelmed by patients …