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At the heart of general practice since 1960

'Statins for all' ruling in type 2 diabetes triggers cost fears

GPs will hand over day-to-day responsibility for many of their most chronically ill patients to community matrons under Government plans to roll out active case management across the country.

The much-heralded matrons will take on a central role within primary care, with responsibility for developing personalised care plans, initiating tests and prescribing, and carrying out medicine reviews.

But the Department of Health, whose plans were unveiled this week, came under fire from both the GPC and RCGP for marginalising the GP role and implying GPs were failing to manage chronic disease effectively.

Primary care tsar Dr David Colin-Thome said nurses would be responsible for identifying the average of 25 patients per practice with multiple conditions and managing their care through personal plans. 'GPs could do this but I doubt they would have the time. We're talking about 18 to 37 hours a week,' he said.

But GPC chair Dr Hamish Meldrum said looking after vulnerable patients was a key part of GPs' role and they would 'take exception' to the suggestion they were not doing it properly. He added: 'If community matrons are going to work they will have to be integrated with general practice and not at cross-purposes. If someone said to me that 20 of my patients were now case managed by Mrs Bloggs, I'd have a lot of questions to ask.'

RCGP chair Dr Mayur Lakhani said: 'We would like to see community matrons based in GP surgeries, part of the primary health care team and ultimately under the supervision of GPs ­ who remain indispensable in treating these patients.'

The department said it believed community matrons would be key to hitting its target of reducing the number of emergency bed days by 5 per cent by March 2008.

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