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At the heart of general practice since 1960

Specialists slam primary care policies

By Lilian Anekwe

Moves to shift work from hospitals into the community as part of the Government's Care Closer to Home drive are vehemently opposed by specialists, a Pulse survey reveals.

Widespread scepticism over the push to provide care in community settings threatens to undermine the policy – and could see consultants thrust into turf wars with polyclinics over provision of services.

A Pulse survey of consultants in dermatology, diabetes and rheumatology – three disciplines in line for massive reforms outlined in the NHS Next Stage Review – reveals that two thirds do not agree with the Government's policy of providing more care in primary care and community settings.

More than four fifths of all consultants surveyed said GPs would not be able to take on the management of patients with more complex conditions in polyclinics or GP-led health centres ‘without significant detriment to the quality of care'.

Dermatologists were particularly opposed to plans for minor surgical procedures to be among the clinical services offered in polyclinics and GP-led health centres – with 85% disagreeing with the move and 80% saying GPs were not adequately equipped or trained to take on the workload.

The criticism is set to reopen the fierce debate over the quality of GP minor surgery, which was recently ignited by an NHS study suggesting it was often of worse quality than in hospitals.

Consultants also had grave concerns about the impact of primary care-based policies, including polyclinics and practice-based commissioning, would have on the care provided to patients in secondary care.

More than three quarters said Lord Darzi's pledge to boost practice-based commissioning threatened to further destabilise their own clinics.

Dr Richard Motley, a consultant in dermatology at University Hospital of Wales in Cardiff, said: ‘We have already seen clandestine use of ‘ring-fenced' monies to invest in GP-delivered work which was formerly delivered in secondary care. It is time to expose this corrupt NHS management initiative from the Department of Health.'

Professor Jonathan Edwards, professor in connective tissue medicine at University College London, said: ‘I cannot see any basis for the shift in rheumatology care closer to home. The evidence seems to be that it is more expensive and less efficient.'

Dr Thomas Poyner, a GP in Stockton-on-Tees with an interest in dermatology, said Lord Darzi's reforms risked starting a ‘turf war' between GPs and consultants.

‘Fewer GPs are doing minor surgery, but those who are still doing it are doing it more. Hopefully that will mean that the minor surgery that is being done will be of a better quality. This will free up secondary care for more complex services. That's what consultants have always said they wanted. It only since funding became an issue that consultants have chosen to fight a turf war.'

Do you agree with Lord Darzi's reforms? (Survey of 62 consultants)

- 66% disagree with moves to shift care closer to home
- 86% disagree that GPs will be able to take on extra work in polyclinics or GP-led health centres
- 77% believe PBC poses a threat to the stability of their clinics

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