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'Children's GPs'? Let's keep the 'general' in general practice

It is imperative that, to be successful in general practice, you need to adapt to changing times.

It is imperative that, to be successful in general practice, you need to adapt to changing times.

The Jobbing Doctor has been practising medicine in the same practice for 30 years now, and what general practice was like in 1980 seems from another era.

Take handwriting, for example. I would not recognise my partners' handwriting now. In 1980 all records were handwritten, and indeed all referral letters were handwritten, except in a few practices that actually had a secretary. My handwriting is like me: small, dark, neat and organised. I could tell my mood from my handwriting (which was always in fountain pen). If it was neat and unhurried, I was relaxed. If I was running late it became untidy and a bit scrawly. Yes, you could tell a lot from my handwriting - except I am not small, dark, neat or organised!

The various organisational changes in the NHS have come and gone, and largely left general practice unscathed. But one of the biggest changes I noted was the so-called Cumberlege report on Maternity Services, which effectively tolled the death knell for general practice obstetrics. The report was not based on sound data and was over-influenced by Government and specialty influences. It meant that GP units closed all over the country, and the three in my patch duly closed. We stopped dealing with maternity cases, and from my seeing a woman 7-8 times in pregnancy and intensively during labour, and afterwards, I was completely side-lined. Most of the cases ended up in obstetric units and the Caesarean section rate mushroomed from around 12% to nearly 40%.

This was a massive change and I very much regret it, and wish that it hadn't happened. But it did.

I feel I am less complete as a GP for having lost out on maternity care. Similar efforts to peel off certain responsibilities which have occurred over the years, usually by Government diktat and with precious little evidence, have been the routine management of breast cases, and also the management of thyrotoxicosis.

Now it seems that the top-down interferers are at it again. They have decided that it would be a good idea for childrens' care to be done by a cadre of community based specialists and paediatric nurse specialists. The rationale for this seems pretty flimsy, and it is another idea that is being promoted from the top down, this time from Yorkshire and London, based on the ideas of ‘Lord' Darzi.

What Lord Darzi knows about community paediatrics is about the same as I know about endoscopic abdominal cancer surgery. That is, not a lot. But at least I am honest about my lack of knowledge.

This is, once again, a manufactured issue with managers saying that 40% of GPs have no specialist experience, and it would be better done by someone else. We end up with an ever increasing fragmentation of provision, and the loss of the central core of general practice, that is dealing with the family.

We have seen how much money has been squandered on Government initiatives such as walk-in clinics, privatisation of out of hours care, independent sector treatment centres, Darzi-style polyclinics and so on to know that the whole idea is deeply flawed. It will not succeed, and will merely divert much needed resources to favoured pet projects of former clinicians. The whole idea stinks.

I don't want true family medicine to be confined to the history books along with maternity care, 24 hour patient care, simple breast disease management and other curios.

Oh, and people writing with fountain pens.

Jobbing Doctor

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