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PCOs failing duty to provide core services

GPs are unable to follow national guidelines in a wide range of clinical areas because of serious gaps in the services available locally, a Pulse investigation reveals.

Obese patients are missing out on exercise referral, patients with severe, unresponsive hayfever rarely have access to a specialist allergist and many trusts do not provide self-care courses for patients with chronic illness.There are also gaps in cardiac and pulmonary rehabilitation along with well-documented problems in access to psychological therapies.The findings chime with the recommendations of last week's report from the BMA, which urged the establishment of a core list of services to tackle the current lottery in access.Pulse gained information from 90 primary care organisations across the UK using the freedom of information act.There were particular shortages in allergy services, with only a third of trusts allowing GPs to refer patients with hayfever to a specialist clinic.Where allergy services were available, there were average waits of 71 days, and in some cases up to five months.A third of PCOs were not providing self-care courses for patients with rheumatoid arthritis, and a similar proportion did not provide dietician advice for patients with irritable bowel syndrome.A third of patients also lacked access to pulmonary rehabilitation courses, and waits averaged two months.Dr Scott Wilkes, a GP in Broomhill, Northumberland – an area where service provision is particularly patchy – said: 'Our exercise referral for obese patients only accepts patients who are damaged by their obesity, for example those who have hypertension. 'Surely it should be available for the 50% of the population who are obese before they are damaged and it becomes a national crisis?'Professor Aziz Sheikh, professor of primary care research and development at the University of Edinburgh, said: 'There is a lot of scope for improvement, particularly in asthma management. Without greater access to specialist care from GPs, lots of people do miss out.'A spokesperson for North-umberland PCT said the funding of services was a matter of priorities. The PCT supported the provision of more services, such as the expert patient programme, and had recently implemented a new pilot scheme for obesity management.

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