Time for the NHS to trust GPs

The DoH tends to regard GPs as 'failed hospital doctors'. Unfortunately, so do some consultants, especially the older ones. Thankfully this attitude is slowly disappearing, helped by greater GP involvement in teaching medical students and junior doctors. Hopefully, in the future the only perceived difference between GPs and consultants will be the area of medicine each has chosen.

In the meantime, we need to seek better integration of primary and secondary care medicine. Why do hospital doctors always repeat GPs' work? Referral letters are often ignored; and the tests we have so carefully performed will inevitably be repeated. In a more trusting world the GP might diagnose, say, a hernia: the patient would then be admitted directly for operation without the need for a prior outpatient attendance to check the GP's findings.

Greater trust of GPs by hospital doctors would also make internal referrals less necessary. I always find it risible that, faced with a private patient with slightly high BP, a surgeon may well cross-refer to a consultant physician colleague. (I'm quite good at treating hypertension myself, funnily enough.)

Yet at the same time, some NHS departments use GPs as referral clerks: 'These headaches may be ethmoid sinusitis: please re-refer to ENT.' GPs aren't skivvies. Were we to use consultants in this way there would be an outcry. And yes, I know this is all about financial control: but it wastes our time unnecessarily, and should be done differently.

The profession needs to consider carefully the medical and financial benefits of tighter integration of primary and secondary care. Costs and workforce demands would drop if the patient was seen less frequently; tests wouldn't be duplicated; the patient wouldn't be inconvenienced as much; job satisfaction would rise all round; and there would be a deeper sense of trust and mutual respect between GPs and consultants.

Practice-based commissioning will help with this. Good commissioning will do away with out-patient appointments after routine surgery, and also prevent junior doctors repeating out-patient follow-ups every six months because they haven't the confidence to discharge the patient. Integrating the work of GPs and hospital doctors is better all round. It's time we got on with it.

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