Letters Lansley’s legacy

Keep general practice and secondary care separate

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6583 (Published 02 October 2012) Cite this as: BMJ 2012;345:e6583
  1. John Fitton, general practitioner1
  1. 1Dryland Medical Centre, Kettering NN16 8JZ, UK
  1. fittonjohn{at}hotmail.com

I was dismayed by Walshe’s phrase “improving the organisation of primary care and its integration with secondary care.”1

My surgery (six full time equivalent partners, 12 500 patients) has as much wish or need to be integrated with any of our district general hospitals as my local garage needs to be integrated with the specialist Audi garage in Northampton.

From a business point of view (and from my years of experience of fund holding in the 1990s), clear clinical, financial, and legal boundaries are needed between what GPs do and what specialists do. The recent blurring of this fundamental NHS idea has been the cause of much unproductive internecine debate and budgetary confusion. The argument for even more “integration” is often made by those who are unfamiliar with the business of “coalface” practice or those who wish to destroy what most patients seem to value—the family doctor in a surgery near their home.

By any international comparison our system of distinct general practice and specialist services is still the most cost effective way of providing a health service. This is despite recent developments having belittled the GP’s gatekeeping and loss adjustor role in what is essentially an insurance based organisation, which—like motor insurance—everyone realises is necessary but few wish to pay much for.


Cite this as: BMJ 2012;345:e6583


  • Competing interests: None declared.


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