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Independents' Day

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Further to the items on GPs with special interests (News, July 9) I would like to make the following points. GPs are generalists. While most have particular clinical interests, this does not equip them to substitute for consultant opinion.

Some GPwSIs carry out little general practice, focusing instead on the specialty and the disease process rather than treating patients holistically.

Creating a tier of GPwSIs is a red herring. Rather than reducing referrals, their extra knowledge heightens their index of suspicion, generating more referrals.

GPwSIs also place an obstacle in the patient's path to see a consultant. Where is the choice? The fairest thing would be to give the patient the choice of referral to a GPwSI or a consultant.

GPwSIs are supposed to save PCTs money; this is folly. If, for the sake of argument, patients are not referred to secondary care, the trust will invariably increase their cost per case. The alternative is political suicide.

Manpower issues remain in primary care. If some of my colleagues are diverted to the new clan of GPwSIs the crisis will be amplified.

We should try to entice retired consultants to return to the fold and provide a community-based service. All GPs should develop their skills to deal with most situations in primary care.

Dr KS Pandher


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