Is there a clinical future for the general practitioner?
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7195.1420a (Published 22 May 1999) Cite this as: BMJ 1999;318:1420
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Dear Sir,
Dr Goss is 'spot on'. This Government is intent on means testing the
population by a process of slow attrition on what I have chosen to call
the 'NHS trampoline'. As month follows month, services become
proportionately reduced, whilst people are jumping up and down on this
trampoline.
As they return to earth, some fall back onto the trampoline (if the
service continues to be provided) and others hit the deck.
Some of these people get back on the trampoline, others feel that
they have had enough and, whether they can afford it or not, seek private
assistance. New Labour has no problem with this.
The aim is to reduce the service to a basic one for all taxpayers
(evidence-based and delivered by salaried, non-advocate, health care
professionals with a strong barefoot element). It will probably consist of
acute care for all and chronic care for those who have been silently
'means-tested' in for centrally decided medical conditions.
We all accept that a visit for an ailing dishwasher is £60 and the
public will be facilitated, with no debate, towards the same notion for
health care. The increase in private providers demonstrates this.
With NHS Direct and other 'jemmies', the populist Tony Blair will
prise apart traditional primary care (and probably open quite a number of
opportunities for fiscal and clinical disaster, including doing nothing to
help the British public to value the NHS or to decrease illness
behaviour).
The challenge will be the provision of continuity of care in a
quality spatio-temporal environment.
How ironical that this could have been delivered by those of us in
the tranche of the early mid-eighties who were fired up, wanted to reduce
list sizes, practice high quality clinical medicine and still believed in
shaping the NHS. I recall encouraging respect for its values and
attempting to reduce illness-seeking behaviour, whilst encouraging
patient self-help and so trying to reduce service use and costs.
This Governemt's solutions and general practitoners' general 'change
fatigue' will, without thought (such as the inadequate provision of mental
illness training to NHS Direct staff) cost the country far more, as more
and more stressed "get it right NOW" British consumers drive themselves
and the NHS into higher and spirals of dependency.
The country has the Government it deserves and the next 10 years will
be interesting. As one of my patients once told me "You worry too much, Dr
Manning - the pendulum never stops in the middle".
Yours Faithfully
Dr. Chris Manning
Competing interests: No competing interests
In asserting a future role for general practitioners, Lipman (BMJ,
318, p1420) is right to foresee the continuing need for personal advice
from a doctor. Nurse-based computer-driven triage backed up by specialist
or
technical referral will not invariably respond adequately to the needs of
the uneasy human spirit.
Lipman implies, though, that the identification of need is synonymous
with the satisfaction of that need through funding under the UK NHS. The
hurried promotion of NHS Direct telephone and walk-in services signify
that British
policy is evolving in a different direction which, like the USA HMOs that
developed the protocols we are using in the UK, aims at limiting the need
for medical involvement.
Political rhetoric aside, the policy is clear. NHS provision is to
be nurse-led and protocol-driven. Care that is doctor-led and judgement-
driven will increasingly become the preserve of those prepared to pay for
it.
Lipman, then, is right, but so are those whose analysis he
criticises. The perceived redundancy is of NHS GPs, not all GPs and it
may take over a decade to happen. The continuing need will be for access
to personal advice from a trained GP. Our services are valued by patients
and are not expensive. The Network for Private General Practice exists to
ensure continuing GP services to patients and the survival of our Art
through the hostile years of 'The New NHS' with its occult intents.
Dr Brian Goss
Network for Private General Practice
Beeches
Lower Olland Street
Bungay Suffolk
NR35 1BZ
Competing interests: No competing interests
Re: Re: Is there a clinical future for the general practitioner?
Of course, there is a future for GPs when they all become 'branch
managers' of the McDonald-style NHS being built all around us right now!
"We aim to please" will become the motto on silly grins. It's all
part of the general 'dumbing down' of everything.
If you want quality, go buy it.
Ahmad Risk
Competing interests: No competing interests