Intended for healthcare professionals


GP cooperatives

BMJ 1997; 314 doi: (Published 29 March 1997) Cite this as: BMJ 1997;314:975

Can improve lives of doctors and care of patients

  1. Jim York, Director, Greater Swansea GP Cooperativea
  1. a Brynhfryd Surgery, Brynhfryd, Swansea SA5 9DZ
  2. b Kimbolton, Huntingdon PE18 0JF
  3. c Ewyas Harold Surgery, Herefordshire HR2 0EU
  4. d The Surgery, New Pitsligo, Fraserburgh AB43 4NE
  5. e Northern Doctors Urgent Care, PO Box 2, Ashington, Northumberland NE63 0YY
  6. f Stroud Health Centre, Stroud, Gloucestershire GL5 4BH

    Editor–I was stimulated, irritated, and not a little upset by the personal view “There's nothing I can do, I'm only a doctor”–but I did not find the article informative.1

    I am a general practitioner in Swansea who worked hard to set up a local cooperative which covers about 70 000 patients, so the anonymous article may well have been aimed at me. I am also an enthusiastic advocate of emergency prehospital coronary care and have gathered information about my own patients which shows that the time from onset of chest pain to administration of thrombolysis is over an hour in Swansea, under the best circumstances.

    The argument that a general practitioner working out of hours is right to delay sending a patient to hospital until he or she has been to hold the hand of the patient is absurd. If I get a call that suggests a myocardial infarction and the ambulance can get there before me, I rein in my enthusiasm and do the pragmatic thing. If I can speed things up, or the diagnosis only becomes apparent on face to face consultation, then I have a definite role.

    To do more than this I need an electrocardiograph, a fax machine, a defibrillator, a fridge to store the thrombolytic drugs, someone trained in intubation, the full gamut of drugs to manage a cardiac arrest, and an ambulance dedicated to the purpose. I also need to be able to focus on this kind of case. With less than these facilities, I am a bumbling harmful amateurish fool, harmful to my patients and to the image of general practitioners.

    The cooperative of which I am a director is too small to purchase these facilities and has not enough members to develop a rota of the minority who have an enthusiasm …

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