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The end of family practice?

With plans for a new breed of paediatric GP spreading across the country, is care of children set to become forever fragmented from that of their parents – and how can the move possibly be cost-effective?

With plans for a new breed of paediatric GP spreading across the country, is care of children set to become forever fragmented from that of their parents – and how can the move possibly be cost-effective?



When Lord Darzi left his role as health minister back in July, few GPs shed any tears. He was a mild-mannered man with an impressive track record as a surgeon, but his failure to grasp even the most basic tenets of general practice had become the defining feature of his tenure. But any thoughts that his departure spelled the end of primary care policy being dictated by specialists were abruptly ended last week, with the release of London's post-Darzi plans for ‘paediatric primary care-based clinicians' to take over many aspects of children's care. The proposal was founded on the former minister's most fundamental misconception, that GPs, as generalists, are masters of nothing. Only by providing patients with greater access to specialist care, he reasoned, could the NHS deliver improved outcomes for patients.

Lord Darzi's driving vision continues to hold momentum, and political capital, even now that he has returned to frontline surgery. London's plans for paediatric care are closely mirrored by proposals under development in NHS East of England and NHS South East Coast, uncovered by Pulse this week. There, too, a network of GPSIs and paediatric nurses are set to lead routine children's care, again on the basis that specialists know best.

It is a simple and apparently irrefutable logic – that being treated by someone who knows a lot about a type of illness makes more sense than by someone who knows just a bit. Unfortunately, like much of what appears to be common sense, it is actually nonsense. Taken to its logical conclusion, GPs would be expected to hand over care in a raft of further specialist areas, from diabetes to dermatology to dementia. Every patient would be orbited by a gaggle of specialists, each dipping in to provide care when needed, before stepping out of people's lives for years or forever. The concept of holistic care would be consigned to history, and so would any sense of GPs as the gatekeepers or guides to the NHS. And, in the new world of financial austerity, just how cost-effective would that panoply of specialists be?

Even by the standards of Lord Darzi's brainchildren, the response from GPs to the paediatric plans has been fierce. GPC negotiator Dr Peter Holden said they would ‘herald the end of general practice'. GPs asked how it could possibly be sensible for a cash-strapped NHS to ask its specialist paediatricians to spend their time managing childhood wheeze, treating a spot of eczema and holding the hands of GPs.

Above all, the plans would be the end of family practice – gone would be the days when GPs played a central role in the care of children and parents alike. As such, they cannot be allowed to proceed in their current form. Indeed, the onus remains on NHS managers to demonstrate there is a need for an overhaul of paediatric care at all.

Over the coming weeks Pulse will be putting managers under pressure to provide evidence to back claims that paediatric care is substandard, and will be pushing for them to consult fully with GPs over any attempts to improve it. We also need your views about the proposed changes. Everyone agrees that children and families need the best-quality care. But does that need to be splintered across specialisms – or can it not be delivered by a committed, expert generalist?

Editorial

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