Chris Lancelot on...the value of GP work

The DoH is piloting hernia operations in GPs’ surgeries. Presumably the GPs performing these operations have had previous surgical experience because procedures like this aren’t normally associated with general practice.

Why are politicians and the DoH hell-bent on making GPs do anything and everything except primary care? Hernia repairs, intermediate care, GPSI work, practice-based commissioning… anything except general practice.

I am convinced that the politicians don’t understand the importance of primary care — and what people don’t understand, they don’t value. Perhaps they have as their model the general dental practitioner, who deals with nearly everything that comes through the door, referring only the most complicated patients (in fact this analogy is specious: ‘general dental practitioners’ are actually specialists — the equivalent of a secondary care unit).

It is easy to see why managers feel that GP referrals should be reduced, if they think the whole of medicine is our job and that, like dentists, we should be dealing with nearly all of it. Certainly, GPs could learn many of the tasks performed by consultants. Surely we should be able to perform gastroscopies, colposcopies and slit-lamp work, and slash our referral rates in the process? Isn’t this ‘proper medicine’? Isn’t this what these expensive GPs should be doing?

But no single GP can develop expertise in all these areas. We could each develop mini-specialisms as part of a large consortium — but there’s a problem with this: time. If we take on large quantities of specialised work, when do we do the primary care? And if we don’t do it, who will? Nurse practitioners are all very well, but most operate within circumscribed areas and all need GP back-up for complex cases. The out-of-hours debacle has shown that the standard of care drops precipitously and A&E is overloaded when GP cover is reduced.

So I have a message for the politicians: learn to understand and value primary care. There is no substitute for it. Destroy the generality of general practice and the nation will live to regret it.

- Dr Lancelot is a GP from Lancashire.

Email him at

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