Intended for healthcare professionals


Tensions in implementing the new genetics

BMJ 2000; 321 doi: (Published 22 July 2000) Cite this as: BMJ 2000;321:240

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

  1. Glyn Elwyn, senior lecturer in general practice (,
  2. Jonathon Gray, consultant in cancer genetics,
  3. Rachel Iredale, project worker
  1. Institute of Medical Genetics, University of Wales College of Medicine, Cardiff CF14 4XN
  2. University Department of Medical Genetics and Regional Genetic Service, St Mary's Hospital, Manchester M13 0JH
  3. Division of General Practice, School of Community Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH
  4. Department of Primary Care, University of Southampton, Southampton SO16 5ST
  5. Department of General Practice and Primary Care, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS

    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 …

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