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At the heart of general practice since 1960

Small practices furious about premises policy

The threat to GPs' core role in co-ordinating patient care became clearer this week ­ Cato Pedder reports

NHS managers want to extend the choice agenda into every corner of primary care, with patients to have vouchers to exchange for the treatment of their choosing.

The NHS Confederation is calling on ministers to go even further in planning patient choice at the centre of NHS reforms. It believes its proposals are the natural extension

of the Government's Choose and Book plans for elective surgery.

The proposals, presented in the confederation's 'election manifesto', would provide all chronically ill patients with vouchers to exchange for the type of treatment, provider and venue of their choice.

A spokesperson for the confederation said: 'Putting patients at the centre of their care, and giving them real choices over their treatment, will work better for them and seem less fragmented.'

But GPs warned that the plans would have exactly the opposite effect and further shatter the continuity of care, already under threat from walk-in centres and active case management schemes.

Dr David Bevan, a GP in Sudbury, Suffolk, said: 'Health care is not a pick-and-mix shop. Choice must always apply after professional diagnosis and judgment.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said: 'The GP, particularly for people with chronic disease, needs to be the centre.

'Providing choice does potentially increase the risk of fragmentation and increases the importance of the GP in helping patients' decisions.'

The confederation said under its proposals, a patient with depression would be able to choose between antidepressants or cognitive behaviour therapy.

Dr Graham Archard, vice-chair of the RCGP, insisted GPs were already offering patients appropriate choice over their treatment.

'There is nothing new about patients becoming informed decision makers in their care,' he said.

The Department of Health is known to be enthusiastic about the patient choice agenda. It would not comment on the confederation's proposals but is launching new plans for extending choice in secondary care this week.

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