Not mentioned in the analysis are the nurses who are trained to deal with a single disease using a specific guideline. A consequence of the arrival of these nurses has been the de-skilling of the GPs who have passed the care of patients for example with COPD or asthma to a nurse.

GPs are the only generalists left in the NHS and they are now exposed by the consequences of the single disease/guideline approach of recent years. They now need to deal with patients with multiple morbidities and need help but not from even more complicated guidelines. What is wrong with the basic clinical training of previous generations of medics who knew nothing of guidelines?

Competing interests: None declared