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GPs' case load gets more complex

GPs are seeing a rapid change in their clinical role as a result of increasing skill mix and prioritisation of areas included in the quality framework, new figures show.

Between 2003/4 and 2004/5 there was a significant decline in GP workload for a number of common presentations, such as depression, fatigue, hypertension and upper respiratory tract infections (see box).

But during the same period GPs saw proportionally far more presentations for skin infections and abdominal pain, according to figures from The Information Statistics Division, Scotland.

The data indicates that other professionals in the primary care team are taking over areas that were traditionally the domain of the GP.

Dr Dean Marshall, vice-chair of the Scottish GPC and a GP in Dalkeith, Midlothian, said older GPs would find the change worrying.

'It's a real concern for some GPs that the role is changing. We're tending to see the difficult cases and could be becoming deskilled in some areas,' he said.

'What we have done in our practice is to train nurses to do minor illness such as upper respiratory tract infections. With hypertension we are using health care assistants to measure blood pressures.'

The data was estimates based on extrapolation from 'spotter' practices in Scotland.

Out with the old, in with the new

How GPs' clinical role is changing (percentage presenting to GP)

Condition 2003/4 2004/5

Abdominal and pelvic pain 52 57 (+5)

Skin infections 52 55 (+3)

Depression and other affective disorders 76 65 (-11)

Acute URTI 80 71 (-9)

Hypertension 83 77 (-6)

Fatigue, tiredness, malaise and dizziness 68 61 (-7)

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