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At the heart of general practice since 1960

PCTs 'will not be decimated'

As GPs attack a skill mix plan as 'the thin end of the wedge', a new pharmacy contract has reignited pay fears ­ by Emma Wilkinson

GPs have condemned a Government plan to shift large chunks of their core work to other health care workers as 'fundamentally wrong' and potentially dangerous.

The NHS modernisation arm has produced a 'shopping list' of 20 areas of GP responsibility that could be transferred to other staff to give patients easier and more cost-effective access to services.

Under the plans, drawn up by NatPaCT ­ the organisation that promotes the modernisation agenda to PCOs ­ health care workers from chiropodists to complementary therapists may diagnose and refer patients for a wide range of conditions from mental health to dermatology.

The organisation is so keen on the scheme that any examples on the list not already undertaken will be commissioned as pilot schemes.

But GPs have poured cold water on the plans. Dr Nick Summerton, medical director for Yorkshire Wolds and Coast PCT, and a GP in Goole, described them as the 'thin edge of the wedge'.

Nurses were good at chronic disease management, he said, but it was 'totally inappropriate' for them to undertake triage, diagnosis and assessment. 'I have seen too many disasters and we have to say no. Patients don't want it and many in general practice don't want it.'

NatPaCT's Working in Partnership Programme, which drew up the list, was established under the new GMS contract to ease GPs' workload by improving the primary care skill mix.

But Professor Bonnie Sibbald, deputy director of the National Primary Care Research and Development Centre in Manchester, warned that if GPs handed over too much responsibility it could damage continuity of care.

'Our feeling is that the loss of continuity might itself have a negative effect on quality because you lose the relationship with the patient,' she said.

GPC negotiator Dr Laurence Buckman said GPs must retain overall care of patients, but added: 'If the monitoring is being done by someone else, that's fine.'

The Government's skill mix shopping list

Under NatPaCT's plan, health workers including nurses, dietitians, chiropodists, pharmacists, podiatrists and counsellors could take on responsibilities including first contact, triage, maintenance, treatment, and onward referral for common conditions in:

·dermatology ·mental health ·gynaecology

·ophthalmology ·geriatrics ·paediatrics

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