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At the heart of general practice since 1960

Dr Mary McCarthy: Elementary? I don't think so Ms May

Dear Prime Minister…

You may not realise how important GPs are to the cost-effective running of any health service, even though there are papers confirming this and proving that GPs are the core of health management.

Maybe you were led astray by the wizard and gate-keeper scenario which gives the impression that GPs are hobbit-like creatures guarding the door for the magic consultant, who is lord not of the rings but of everything – and certainly it appears that is the way your government thinks, with consultant numbers rising year on year while GP numbers decline because, after all, you can always find another gate-keeper, can’t you?

This picture is false and gives the wrong impression of how a health service works.

There is no wizard and no gatekeeper. There are GPs who are highly trained doctors, honed by years of experience, who deal with distressed and anxious people. These doctors are recognised as specialists throughout Europe and in Canada, the US and Australia. They are specialists in family medicine, specialists in diagnosis and risk management – what the Canadians call ’Doctors of Unrestricted Scope of Practice’.

They are the front door of any successful health economy.

They are the doctors who listen to their patient’s stories, who tease from confused narratives the relevant threads of a possible diagnosis, who explain to patients the disease and its implications. They organise the investigations, blood tests, X-rays or scans that will confirm their thoughts and review results with the patients. They will start treatment or arrange referral to secondary care colleagues, often contacting them personally to expedite the appointment.

In this story, they are the detectives. They are experts who interrogate, who gather clues, who arrange forensic examinations and who solve the crime and identify the disease.

We are the Sherlock Holmes of medicine.

When patients are referred into hospital, they will have a good idea of what is wrong with them and what the next steps are. Their next appointments are with ’Doctors of Restricted Scope of Practice’.

GPs, especially in the UK, deal with everything and cope with everything. They sort out minor from major problems even when the presenting symptoms may be trivial in both cases. Feeling tired could be because the patient is anaemic, or it could be a symptom of diabetes, or thyroid dysfunction. Tiredness can be caused by kidney failure or heart failure. It can be because you don’t sleep well due to sleep apnoea or due to a crying baby. It might be because your job is wearing you down or you have had a recent bereavement. It can be because you’re depressed but it might also be because you have cancer. A GP can sort this out and find, with the patient, the best way forward. Other health professionals working in primary care do not have these skills or the expertise necessary.

No one else can work as a GP except a GP. We are the Specialists in General Practice/Family Medicine.

Dr Mary McCarthy is a GP in Shrewsbury

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