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Independents' Day

GPs to lose role as NHS gatekeepers

GPs' traditional gatekeeper role is to be swept away under Government plans to increase patient choice.

The far-reaching reforms will also allow patients to register with more than one practice ­ an option dismissed as unworkable by the GPC and NHS Confederation early in the GMS contract talks.

GPs warned dual registration would encourage patients to 'game' the system by seeking second opinions and would cost more as two GPs would need to be paid for each patient.

They also expressed fears over proposals to allow patients to go directly to a specialist for treatment if they have been referred to them before, claiming it would increase waiting lists and produce worse health outcomes.

Department of Health patients' tsar Harry Caton, architect of the white paper published last week, told Pulse patient choice had to be improved, whatever the obstacles. 'The way to approach things is to say if this is a good idea we must find a way to implement it,' he said.

'The question is whether we can develop some of the services using nurses and other health professionals and have GPs play slightly less of a gatekeeper role and use their skills more appropriately,' he said.

Other proposals include pharmacists taking over repeat prescribing and more chronic disease management ­ and for out-of-hours providers to offer more in-hours services.

GPC chair Dr John Chis-holm said proposals for self-

referral by patients would not be cost-effective and any plans for dual registration would need to ensure both practices were paid for the patient.

He added: 'We believe you get a more cost-effective service that is better for patients and produces better health outcomes if the referral is made through a GP.'

Dr David Reade, a GP in Liverpool, said dual registration was 'wide open' to abuse. 'We've got eight partners and already have patients who play one against the other,' he said.

Patient choice white paper

 · Patients can register with a practice near their work and one near their home

 · Patients can see specialists without GP referrals

 · Out-of-hours providers to offer daytime services

 · Chronic disease monitoring done by pharmacists

 · Repeat prescriptions obtainable from pharmacists for a year without returning to GP

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