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'Practice-based decommissioning' could save us money

From Dr Bernard Newgrosh, Bolton, Lancashire

Pity the poor community matron who, as described by Phil Peverley, was asked to check on an asthmatic with normal blood pressure (Columnists, 15 February). She was made an offer she could not refuse!

But to see the wider picture, just look at the phenomenon of the unnecessary referral made by one polyhelper to another. Time was when no such referrals were made: nobody would presume to do the GP's work. Nowadays such referrals are scattered like confetti. Why?

I have wondered if the polyhelper multiple referral phenomenon represents 'distraction therapy'. For instance, when a child presents to the casualty department with a head injury, the family is treated in an offhand manner. Their attention is distracted by the referral to a consultant dermatologist for the child's truly minor eczema: the family start to wonder if their GP has missed something serious. They return to primary care where they are reassured that they can believe the evidence of their own eyes, that the eczema is responding nicely to 0.5% hydrocortisone cream.

Alternatively, I have wondered if the phenomenon reflects a basic insecurity on the part of the person making these referrals. A desire to do, and be seen to be doing, everything possible.

But I've finally decided on the cause of the phenomenon: the GP role has become so blurred that everyone wants to get in on the act. Nurse is the new GP; physiotherapist is the new GP; community matron is the new GP. Trouble is, they are nowhere near as good at it as we are. And we can see to it that they never will be! Here is my cure.

In an age when all kinds of GP referrals to secondary care are filtered by polyhelpers so that so-called unnecessary ones can be weeded out, there is a much greater need for those not made by GPs to be similarly filtered. We can call it 'practice-based decommissioning'.

We can use practice-based commissioning as our model, introducing standard clauses into the contracts:

1. All referrals made outside primary care have to be referred back to the practice to be approved or disapproved. This will command a fee, payable by secondary care. The inappropriate referrals will then cease, to be replaced by 'the old system', featuring recommendations and GP discretion.

2. We can insert an 'answer the question' clause into the contract, stipulating that we want a specialist opinion on a particular problem but that holistic care is best done in the primary care set-up.

If PBC is really about

saving money, we should be allowed – nay, encouraged – to take such action. With practice-based decommissioning, there is heaps of money to be saved!

• From Dr N Kolla, Sunderland

Phil Peverley's piece about his evening at a walk-in centre contains statements that

are not true (Columnists,

8 February). I have been working for Primecare from the same premises for a year.

To start with there will be only two GPs on site working from 6pm to 10.30pm weekdays. These GPs don't take the telephone calls that should go to GP surgeries hence the phones will be quiet most of the time. The calls will be taken by a central triage pool in Birmingham. They book

the appointments at the

out-of-hours surgery run by Primecare according to patients' choice. Some of the appointments will be filled by referrals from the walk-in centre in the same premises and some from the central triage pool. Hence, there will be a mixture of caseload.

The same premises are also used during the daytime to run community diabetes and cardiac failure clinics. The equipment in rooms is used by the day staff for educating and investigating patients.

I have heard many patients praising the service provided. This will also be evident from the patient questionnaires done by both Primecare and walk-in centre staff. I think that we should be optimistic about the money being used

by the PCT in building such premises.

Articles such as Phil Peverley's can damage the reputation of the professionals working in such areas.

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