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GPs are best - but don't just take my word for it

A couple of new studies challenge the wisdom of hiving off care to specialists and shiny new primary care providers

By Richard Hoey

A couple of new studies challenge the wisdom of hiving off care to specialists and shiny new primary care providers

Every so often, a piece of research comes along that brings a smile and, in less charitable moments, an ‘I told you so' to your lips.

A few weeks ago, it was the Commonwealth Fund's international survey of general practice that had British GPs puffing out their chests after finding they were providing some of the world's best care for chronic illness.

And in the last few days, a couple of different studies have been published that seem purposely designed to make GPs feel good about themselves, and bad about Government policy.

A systematic review of 22 studies from around the world has found GPs and their international equivalents are just as good at looking after chronically ill patients as when their care is hived off to specialists.

Outcomes for diabetes, rheumatoid arthritis and cystic fibrosis (admittedly not typically cared for by GPs in the UK) were just as good under generalist care as when led by specialist centres.

Now OK, there's a few caveats to a study like this. The data set was, in academic terminology, ‘heterogeneous', and the results came from just three chronic diseases. No one is about to pretend we can close all our hospitals and send consultants out to sweep the streets.

But the results do add to a growing feeling that the Government – and particularly GPs' old nemesis, Lord Darzi – have over-emphasised the importance of providing patients with routine access to specialists.

The original polyclinic concept was developed to bring specialists into the community (even though other research out there has dismissed that option as not cost-effective), and the latest proposals on ‘children's GPs' are yet another example of the assumption that specialists know best.

There's an increasing feeling among many GPs that Government policy is fragmenting care across numerous different providers – which is where our second piece of research this week comes in.

A study in the British Journal of General Practice has found that walk-in centres are working in some cases at little more than a fifth of their expected capacity, meaning they are costing up to £62 per appointment.

I think most GPs would feel one of those less charitable moments was justified here.

I told you so.

By Richard Hoey, Pulse editor

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