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GPs' use of statins varies sharply between PCTs

Pulse has asked a group of GPs to write open letters to ministers to contribute to the Government's 'listening exercise' for the White Paper on the future of primary care.

Here Dr Dinah Roy, PEC chair of the PCT in Tony Blair's constituency, makes a plea on behalf of small practices.

GPs are trained to use their experience to take risks and deal with uncertainty. Our raw material is the unique patient story. This throws light on the complexities of life and disease. It also helps us choose how to apply our scientific learning within a continuing therapeutic relationship to achieve healing ­ or, equally, to avoid the trap of over-investigating physical symptoms. That, at least, is how I learned to practise medicine as a GP.

Personalised care, and the high levels of patient satisfaction that go with it, are known to be more effectively delivered by smaller practices. Yet today's world of singlehanded general practice is endangered.

Evidence shows smaller practices struggle to provide the quality of infrastructure that their larger counterparts can achieve, but there is no evidence of any difference in quality of care.

It may be easier for a larger practice to provide speedier access for patients both to different specialist practitioners and to a wide range of systematic chronic disease management programmes. Such services may well be appropriate for the patient, but we must not allow them to divert the focus of the experienced generalist's eyes from the whole patient.

Small practices may be more cost-effective than is assumed. Benefits of patient-centred care include a huge risk-management function for the NHS. This is almost unquantifiable and would be impossible to achieve with existing resources in a highly task-oriented system that is over-dependent on protocols, checklists and the fragmented view of patients that you get from looking at them too closely through ICD-10.

Greater support for small-practice infrastructure, possibly using a 'virtual supersurgery' model, may be the best thing the White Paper could achieve for general practice and patients.

Dr Dinah Roy is a singlehanded GP and PEC chair of Sedgefield PCT

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