Chris Lancelot: NHS risks losing the generality of primary care

I am constantly irritated by the paradoxical attitude of the NHS towards competence. On the one hand it rubbishes the qualifications of fully vocationally-trained GPs by insisting on further evidence of paediatric, resuscitation and minor surgical abilities, while on the other it pushes us into jobs for which we have no formal qualifications at all.

To counter this the BMA has been holding conferences to teach GPs about business law, bidding and tendering - as if we don't have enough to do keeping up with the medicine.

Why does the NHS do it? GPs with no formal management qualifications are expected to run practice-based commissioning groups. Those with no training in IT are expected to become dab hands at data processing. Nursing is the same: for years the NHS has been encouraging hospital sisters to become nurse managers instead of hands-on nurses. And we mustn't forget that nurse practitioners have had to learn to make diagnoses - for them, a completely new skill set.

On the plus side, it is gratifying to see how well many of these clinicians have performed in their new roles. Nurse practitioners can often outshine doctors in their area of specialisation; and I know a number of GPs who appear to be better at IT than all of Connecting for Health put together.

But the conundrum still remains: why does the NHS constantly ask its staff to work outside their core expertise?

To use healthcare professionals in this way creates three problems. GPs who take on these extra roles risk not being adequately trained for their new jobs. Additionally, the time needed to acquire this new expertise inevitably erodes into time set aside for their orthodox medical updating.

But the biggest mistake of all is that if the government doesn't value ordinary GPs and instead badgers us to work in alternative fields, then too little time will be left for what we are good at - general practice.

The more the NHS discounts orthodox GPs by trying to turn us into mini-specialists, managers and entrepreneurs the more it risks losing the generality of primary care. Constantly pushing GPs away from our core work of hands-on general practice doesn't enrich the NHS: it impoverishes us all.

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