Generalist role 'under threat'

The generalist role of GPs could be lost if the shift of secondary care to the community goes ahead, say UK researchers.

A report on the first year of demonstration sites providing 'care closer to home' has highlighted concerns that some GPSIs will lose their generalist skills while other GPs will become less involved in certain aspects of care.

The comments came from those involved in 30 pilots providing dermatology, ENT, general surgery, gynaecology, orthopaedics and urology.

The services were set up in response to recommendations in the White Paper 'Our Health, Our Care, Our Say', published last year. Following analysis of outcomes from September 2006 to May 2007, the National Primary Care Research and Development Centre (NPCRDC) in Manchester said: 'Comments were made that the development of GPSIs could either up-skill or de-skill existing GPs.

'They could de-skill them by taking existing routine care out of general practice (possibly appropriately) leaving GPs with a more restricted workload.'

Dr Richard Vautrey, GPC deputy chairman, agreed that the generalist role may be at risk.

'If specialism is seen as more worthy than a generalist approach, there is a risk of this happening,' he said. 'There's a real tension about how you preserve the generalist role and support those who want to be a specialist.

'The key is to be generalist first, specialist second.'

RCGP vice-chairman Professor Nigel Sparrow also called for the preservation of the generalist role.

'GPSIs supplement their generalist skills with more specialist knowledge,' he said 'They are GPs for the majority of the time; the specialist role is just a small part of their weekly work.'

NHS Employers' deputy director Sian Thomas reportedly said this week that there was no future for GPSIs and care in the community should be carried out by hospital specialists.

This was despite the White Paper saying that moving specialist care into the community would free up consultants' time.

Despite concerns about conflict between consultants and GPs at the pilot sites, in a DoH report based on the NPCRDC findings, health minister Ben Bradshaw said the outcomes were 'powerful levers for change'.

rachel.liddle @haymarket.com

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