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GPs worry appraisal will be tougher

I was surprised to read your articles relating to enhanced services and the fact the 'battle had been lost'. I had not actually realise we were supposed to be at war.

I have tried to work constructively with the local health board and local hospital in one small area which I saw as a priority, that of shared care. This is an important clinical governance issue and needed to be addressed.

Research from the MDU lists long-term complications of drugs that have not been appropriately monitored as a significant cause for litigation. GMC guidelines indicate that doctors need to be fully aware of problems relating to drugs that they prescribe, and that they should not be bullied into prescribing medication they are not familiar with. Government agencies also clearly indicate that prescribing and monitoring are best carried out by the same person.

When I sat down with the local health board and hospital we realised we all felt that an appropriately resourced shared-care scheme was the best way forward. The hospital felt unable to take back the prescribing and it was obviously inappropriate for GPs to continue prescribing without appropriate support.

An effective shared-care scheme was also felt to be of benefit to the patients, reducing the risks of medication while enabling access at a local level. Funding this through general practice was also considered cost-effective compared with the resources the hospital would have demanded to provide the same service.

Bridgend has recently sent out shared-care contracts for amiodarone, azathioprine, leflunomide and hydrochloroquine. All these have been funded in a similar fashion to that outlined in the contract and are in addition to the enhanced services already agreed across Wales, in an area spending above the floor. There are more to follow, with the issue of lithium being currently addressed.

In an ideal world it would be good to resolve the problems with enhanced services by getting all sides of the NHS working together through common interest. It is a question of getting all the sides to identify problems and the best way to resolve them. This will usually benefit patients in the longer term and GPs should bear this in mind.

If this is to be a war then we need to think World War I. We should not expect it to be sorted by Christmas. If it does turn into a battle it will be a long drawn-out war of attrition. But we need to remember that we are on the right side.

Wanless clearly indicates that more care needs to be delivered in the community and resources need to be redirected/made available to achieve this. It states that unless this is delivered the NHS is not sustainable.

I believe at some stage even health service managers will recognise this. Until then we need to keep grinding away.

Dr SP Young

Cwm Garw Practice

Pontycymer

South Wales

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