Darzi must not ignore secondary care

MRSA and GPs are the twin scourges of the NHS.

Or so you would believe from the coverage of the Darzi report on the NHS, although it is not clear if he wants to eradicate both.

Given Lord Darzi's earlier report on the NHS in London, it should not have come as a shock that he favours polyclinics and extended opening for primary care. He also emphasises that patients want to be seen as people not as numbers and that they 'want their care to fit into their lives'.

The problem, as with much of this type of populist policy, is that some of this thinking is contradictory. If polyclinics are the answer to modern healthcare delivery, then there are sacrifices to be made, in particular a strain on the doctor-patient relationship as GPs are moved further away from patients. It is also worth noting that patients are more likely to 'feel like numbers' in secondary care settings where they do not have established relationships with their healthcare providers.

To help healthcare 'fit into patients' lives', Lord Darzi proposes extended hours in primary care, but does not address the same issue for secondary care. So it is not acceptable to attend a GP appointment during working hours but patients won't mind going to outpatients during the day for the same condition? This solution is incomplete and fails to address the nub of the problem that the UK's 60.6 million patients all have different lives.

To achieve his vision, Lord Darzi proposes 100 new GP practices, 900 new GPs, practice nurses and healthcare assistants and 150 health centres opening until 8pm. As GP went to press, we were awaiting details from the chancellor's spending review on how this expansion was to be financed. Switching 60 quality points to opening hours, as is rumoured, and the report's implication that the MPIG could be axed may not offer the answer.

There is much in the fine print of Lord Darzi's report that requires scrutiny in terms of health promotion, patient focus and quality care, but his ideas require investment and should be applied equally and sensibly across the whole NHS rather than picking on GPs alone.

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