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Dyspepsia referral: is NICE right or wrong?

Dual registration and more choice are top of the Government agenda ­ but is that what patients want?

General practice is to undergo yet another massive overhaul after the Government signalled primary care would be the focus for the next round of its NHS reforms.

Changes will include allowing patients to register with more than one practice and a huge rise in private providers competing against GPs.

Health Secretary Patricia Hewitt said past reforms had been directed at hospitals, but it was now time to 'focus more closely on family health services offered by GPs...and others in primary care'.

Although 'most people value greatly the continuity of care offered by their GP',

Ms Hewitt said, they also want- ed more choice of providers.

A new white paper to be released in the autumn would 'set out a vision for family health services fit for the 21st century', she added.

A senior Department of Health official told Pulse dual registration 'will certainly be in there'.

The official added that further moves to 'widen choice into the community' by increasing private sector involvement in primary care would also be proposed.

PCTs can already use APMS to bring in private firms, but the Government is known to be frustrated at the slow take-up by trusts.

A briefing document to accompany the Queen's Speech said the private sector would be used to address under-capacity, widen access and introduce more 'flexibility and responsiveness'.

But GPs said continuity of care would be undermined by an explosion in alternative providers. They also voiced fears that private firms would be incentivised to move into primary care by guarantees of work.

Dr Hamish Meldrum, GPC chair, said competition must be on a level playing field. He said: 'Why should we have to compete with one hand tied behind our back?'

The GPC has previously said it is in favour of dual registration in principle but doubts whether it can be made to work.

Professor Mike Pringle, professor of general practice at the University of Nottingham, said widespread use of the private sector risked damaging the quality and value for money offered by existing primary care services. Private sector solutions must be 'well justified', he said.

Plans for practices to play a greater role in getting people on incapacity benefit back to work, announced in the Queen's Speech, were also criticised by GPs.

Dr Simon Fradd, GP lead for Developing Patient Partnerships, said: 'GPs don't know anything about someone's workplace and what changes you would need to make there to get them back into work.'

By Ian Cameron

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