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CAMHS won't see you now

Still fuzzy over hepatitis B

Ministers must preserve GP role

Pulse has asked

a group of GPs to write open letters to ministers to contribute to the Government's 'listening exercise' for the White Paper on the future of primary care ­

this week: NHS Alliance chair

Dr Michael Dixon

Dear Health Ministers

It is crucial that the forthcoming White Paper both celebrates and extends the role of GPs as generalists providing personal care and continuity to patients on a registered list.

Other professionals (such as nurse practitioners and allied professionals) can undoubtedly do much of a traditional GP's work.

But our core work as complex diagnosticians and holistic practitioners will always remain unchallenged, especially in patients with many symptoms, serious disease or where the problems cross the interface between mind and body. No profession can do it better and no primary care system in the world can claim to do it as well.

If we lost this role, our patients would end up going from pillar to post. They would have this symptom, bad organ or that disease treated here and there with no one person ever being responsible for their care. The result would be fragmented and poorly co-ordinated care.

We must develop our skills as generalists and as a 'one-stop shop' for most of the problems that patients present to us. We need better access to diagnostics (such as ultrasound and MRI) and more time to provide a complete service for each patient. The latter should be one beneficial result of practice-based commissioning as, for the first time, the individual consultation will have an 'opportunity cost'.

In future, we should have the choice as to whether we put our money into longer consultations, where we can treat patients more fully as generalists, or into more prescriptions, diagnostics or referrals.

When I talk to patients, friends or colleagues who are growing old, they all attach great importance to having an ongoing relationship with a GP they can trust. Evidence suggests this is equally important for those with very serious or long-term disease.

This is the bit that British primary care does best, when it is at its best. It can be emotionally taxing and means going that bit further with each individual patient.

But it is also emotionally rewarding and there are great benefits to the GP as well as the patient. We lose it at our peril.

Dr Michael Dixon

Chair, NHS Alliance

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