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“The capability of saving lives” moves to primary care

BMJ 2001; 323 doi: (Published 15 September 2001) Cite this as: BMJ 2001;323:592
  1. Bryan Christie
  1. Edinburgh

    More lives will be saved in future in general practice than in hospitals as the power of family doctors to intervene on behalf of patients increases. That was one of the predictions made by Sir Denis Pereira Gray, a former president of the Royal College of General Practitioners, in wide ranging review of the past, present, and future of general practice in the United Kingdom.

    Hospital activity is increasingly focused on the business of repair, Sir Denis argued, whereas family doctors can now prevent premature deaths from conditions such as ischaemic heart disease by helping patients to reduce their blood pressure and cholesterol, to stop smoking, and to take more exercise. “The capability of saving lives is moving to primary care,” he told the British Association's Festival of Science meeting in Glasgow last week.

    Sir Denis described general practice as one of the success stories of modern Britain. He warned, however, that it has suffered from under-investment and is on the brink of further major change. He forecast that general practice in the future would become less local and less personal as practices amalgamated to provide extra services for their patients. Although it would remain a “people orientated service” he said there was a danger of losing the continuity of care that has been so important in building up trust between doctors and their patients. The genetic revolution will also affect GPs as diagnoses are made on the basis of patients' family history, he predicted.

    GPs are likely to lose some of their current freedoms as they come under increasing scrutiny in a service that will have a much greater managerial input than at present, suggested Sir Denis. “We are in a less trusting age, and we have had some tragic failures. It is a difficult time and the price we have to pay for that will be some loss of freedom.”

    He pointed out that the past 50 years of general practice in Britain had been a time of continuous change, but he added: “I think it will still be a great job to be in, working in the front line of the health service.”

    Professor Martin Roland, director of the National Primary Care Research and Development Centre in Manchester, suggested that some patients were likely to become better informed because of the internet but that these new opportunities were likely to be exploited by more affluent people whose health was already good.

    A demonstration project run in inner city Manchester found little interest among poorer families in using the internet to access health information. Professor Roland said the “digital divide” would not be breached by simply providing access to computers, and tackling underlying problems such as poverty, unemployment, and social exclusion were needed to help improve the health of the poorest sections of society.

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