GPs are the glue holding the NHS together

When does a dive become a dive? Standing on the diving board? In the air? Entering the water? In truth, each part is integral to the whole and cannot be taken out of context.

Yet I suspect the government doesn't realise that primary care closely mirrors this situation: analysing and compartmentalising general practice too precisely misses out the importance of the overall activity. It is well known that many aspects of general practice can be performed by chronic disease and minor illness nurses. Recently there have been suggestions that pharmacists could reduce GPs' workload hugely by performing medication reviews and even monitoring chronic illness. Soon there won't be anything left for the GP to do: therefore we contribute nothing, and as such are greatly overpaid.

But in trying to dissect our role too carefully, the government is missing the point. We GPs tie things together; we pick up loose ends; and in particular we act as back-stops on all those occasions when other healthcare professionals get out of their depth, or where the patient's illness covers several different specialties.

It is always said that the first 95 per cent of any job is easy and takes 5 per cent of the time, whereas finishing off the remaining 5 per cent absorbs 95 per cent of the effort. This last part is where GPs are particularly valuable - patiently getting to grips with the difficult, long-term management problems that the hospitals can neither cope with nor cure. It is not high-profile work, unlike transplants and HIV research, but is probably more significant.

Because 'real' general practice is so hard both to classify and comprehend it is easy for non-GPs to think that we could (and should) be replaced by much cheaper and less well-trained practitioners - but this misses the point entirely. We sort out the difficult and complex long-term situations: we are the glue between the specialties. Observe what happens when GPs are taken out of the equation: costs rise, quality drops and patients become dissatisfied.

Patients understand this, which is why they have responded so magnificently to the 'stop the polyclinics' campaign: they know what they stand to lose if traditional general practice is forced out. It's a pity the DoH doesn't share their insight.

Dr Lancelot is a GP from Lancashire

Email him at GPcolumnists@haymarket.com.

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