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At the heart of general practice since 1960

Disease prevention to be at core of revamped NSFs

Government plans to introduce a network of US-style 'physician practitioners' to do 60 per cent of GPs' work are being branded a 'quick fix' that will further fragment care.

The RCGP has warned that physician practitioners, who are supposed to ease GP workload and improve access to health care, may make health inequalities worse.

The college also cautioned that Department of Health plans would mean physician practitioners working 'with a high degree of autonomy', rather than alongside a GP as part of a team, despite receiving just two years' training.

The new role has been piloted in the West Midlands and London, with practitioners working under the supervision of GPs in practices.

Dr Mayur Lakhani, RCGP chair, said he was worried by ministers' enthusiasm for filling the new positions by 2007 after just two small pilots. 'Our main concern is standards must not be lowered,' he said. 'The name implies they are a doctor but how can someone with limited training deal with the uncertainty of being a GP?'

Dr Lakhani added nurses were being overlooked as possible recruits in favour of other personnel such as army cadets and drug reps.

The college said it had lodged its objections with the NHS Modernisation Agency.

Its concerns were backed by Dr Ian Walton, a GP in Tipton, West Midlands, who is involved in the pilot scheme.

Dr Walton said he was worried practitioners would be put in posts before their training was complete because the Government wanted to solve the workforce crisis quickly.

'It has been tried and tested for 35 years in the US, but it works because of very intense training,' he said. 'I am worried that here they can put people in post and train them in post and in a position where they won't be safe with patients. They need adequate training and supervision.'

GPC deputy chair Dr Laurence Buckman said the only people who could do 60 per cent of GPs' work were GPs.

'The public know quality when they see it,' he said. 'No sane Briton would welcome my intervention in their head just because I claim to be a brain surgeon.'

What will physician

practitioners do?

·Obtain full medical histories and perform appropriate physical examination

·Diagnose, manage and treat illnesses

·Request diagnostic tests and interpret the results

·Provide patient education and preventive health care advice regarding medication, common problems and disease management issues

·Decide on appropriate referral to, and liaison with, other professionals

·'Function with a high degree of autonomy in terms of clinical competencies in health assessment, decision-making, diagnostic reasoning skills, planning, implementation and evaluation of episodes of care'

Source: NHS Modernisation Agency

By Ian Cameron

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