GPs perfectly fit for post-op checks
Professor Martin Roland says the dismay sparked by the primary care tsar's proposals for GPs to take on up to three-quarters of a million post-operative checks a year is misplaced. He insists GPs have nothing to fear
So David Colin-Thome says patients don't need to go back and see their surgeon after routine operations. And GPs are worried that they will be landed with lots of extra work; but do they really need to be concerned? Our research suggests they don't. We carried out a controlled trial to see what would happen if patients weren't given a follow-up appointment after uncomplicated operations such as hernias and cholecystectomy1. We found no difference in visits to the GP when patients were discharged without a follow-up appointment. The only other similar trial came to the same conclusion2.
Patients already come and see their GP when they've been in hospital. They come and see us for certificates, or to have their stitches out, or just to check on progress. In fact, the follow-up hospital visit sometimes delays recovery. How often do you say 'I'll sign you off till you've seen the hospital', when the patient is perfectly fit to return to work? If we took responsibility for saying the patient had recovered from their operation, some people would get back to work sooner.
No training gap
Some GPs doubt we're trained for this work. This doesn't ring true to me either. What we do often lack is really good information about what to expect after particular operations. This could be included in an information sheet provided to both the GP and the patient after every operation. In fact, why don't we get this anyway? Surgeons could also include an evaluation form for the patient (or GP) to send back.
There might be other reasons for patients to go back to the hospital after straightforward surgery. Surgeons, especially those in training, may need to inspect their handiwork. However even this doesn't work at present, as patients are far from guaranteed to see the surgeon who did the operation.
The other side of this issue is that if patients aren't going to get routine post-surgical appointments, GPs have got to have easy access to the clinic when we do want them seen. Not some half-baked anonymous appointment system –
just a single phone call resulting in an appointment at the next clinic. Another
of our studies3 suggests that patients are quite good at deciding when they need to see a specialist for follow-up, so they could also be given the clinic number to use if they think they need to be seen.
So are worries about GP workload or training good reasons to keep sending patients back to the hospital for routine post-surgical checks? I don't think so.
And will practices want to pay for routine post-surgical follow-up in the world
of practice-based commissioning?
I doubt it.
Martin Roland is professor of general practice at the University of Manchester and director of the National Primary Care Research and Development Centre. He works part-time as a GP in central Manchester