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When myths drive policy

Last year's primary care white paper was bursting with the grand rhetoric of a fundamental overhaul of NHS finances, with money to follow patients from hospitals into the community. The argument went that general practice was by far the most cost-effective section of the NHS, so the more work delivered there the better.

But a new report for the Department of Health has questioned some of the key assumptions that lie behind this policy drive. Primary care will not always be cheaper than hospital-based care, apparently, and neither do new GP services always produce the desired reductions in demand for hospital.

Generalists undervalued

For GPs this is mixed news. The shift to primary care brings with it the promise of new investment and opportunities – but also extra work, some of it falling uncomfortably outside the standard remit of a GP. And here lies the kernel of the problem, because there is an increasing feeling that the policy wonks and health economists have failed to fully understand the GP role, or to properly value generalists for their own sake.

Not that there is much chance the Government will listen to its own report, let alone recast policy to take into account the doubts. Like a battered tanker, listing and spilling oil, the department often seems incapable of changing path. Which makes it even more important that ministers check their policies are watertight before launching them on such stormy waters.

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