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Do we actually need all of secondary care?


Dr David Turner


The title to this blog may seem flippant – there are plenty who will dismiss this question as a joke – but I’m only partly joking.

Why? Well, let’s start with CAMHS referrals for eating disorders. Many practices, like my own, will, over the last few months, have had the experience of referring a child with an eating disorder to this secondary care service and then receiving a reply which in the same sentence accepts that the child needs their care, but as they’re unable to cope with the workload currently, ask primary care to monitor them weekly until they can find an appointment slot.

 Let me be clear – they’re asking us to undertake work in a specialist area of paediatric psychiatry within primary care, without funding or appropriate training.

I guess that while we do crash courses in paediatric psychiatry, we should perhaps also brush up our skills treating young adolescents with depression.

The BNF clearly states that antidepressants in those under 18 years of age need to be started by a specialist in secondary care.  As accessing the latter isn’t dissimilar to attempting to get an audience with the Pope, we’re increasingly being left to initiate and monitor these depressed children in the community.

It’s not just psychiatry. Rheumatology regularly asks us to do all their drug monitoring for patients on DMARDS, and as I do in-house steroid joint injections, we never bother them with that work.

In our practice, we offer cryotherapy and minor surgery to treat and excise a range of skin lesions, and even initiate roaccutane for acne. Other than for skin cancer, why do we need dermatologists? I’m not really sure, as all they seem to do at the moment is look at an emailed photos of skin rashes and recommend treating with steroid cream – something we never would have thought of ourselves.

We regularly work our patients up to the point of having had a CT scan before we refer under the two-week wait system for many abdominal and chest conditions. So secondary care input is often not much more than that of a technician, undertaking endoscopies and bronchoscopies – and many of these procedures are done by specialist nurses.

ENT seem only to want to rule out inner-ear tumours, then send the patients back to us to sort out their dizziness and vertigo.

Recently we even had a hospital discharge report asking us to undertake a top-up blood transfusion for a patient, in the community!

Secondary care is failing for multiple complex reasons. More than anything, it’s a massive lumbering beast that’s too weighed down with bureaucracy and red tape to change direction with any speed.

Primary care however, as has been proven time and again, is nimble, flexible, efficient and extremely good at responding rapidly to change.

In short, give us the space, time and resources, and we can do a lot of the work of hospitals more quickly – and at a fraction of the cost.

Dr David Turner is a GP in Hertfordshire

READERS' COMMENTS [8]

Thomas Robinson 28 June, 2021 5:55 pm

So where would the space time and resources come from

Well out of a fund, currently spent appallingly by secondary care, who are unlikely to relinquish their control voluntarily. It would have to be taken off them, and given to the GP, who could access it himself, or pay the hospital

We could call these GP’s fundholders, and they would doubtless demonstrate how hopelessly inefficient the secondary care is. Such would doubtless be the scale of the embarrassment, they would be abolished. Probably when a labour government came to power.

A truly revolutionary proposal, but then that’s what revolution means, going around in circles.

James Cuthbertson 28 June, 2021 6:21 pm

Perhaps GPs need to get some balls and demand what they’re worth from the government?

John Graham Munro 28 June, 2021 8:42 pm

James Cuthbertson—–and in the meantime, stop working overtime thereby nurturing their nervous breakdowns

terry sullivan 29 June, 2021 10:57 am

most doctors are mugs

John Graham Munro 30 June, 2021 1:15 am

Terry Sullivan——–Couldn’t agree more

Louisa Shillito 30 June, 2021 6:27 pm

This is a bit of a silly article, akin with Daily Mail-style ‘what do GPs ACTUALLY DO?’ sloppy journalism. To which our reply is usually ‘we’re working our socks off and they’ll miss us when we’re gone.’
We need primary AND secondary care to be properly organised and adequately resourced.
Which is as likely as pigs flying (or that audience with the Pope!)

Patrufini Duffy 5 July, 2021 1:11 pm

The big elephant in the room is called TARIFF. Anyway – the Americans are here. So – let’s just get used to waste and back hand deals. For zero impact.

John Glasspool 7 July, 2021 8:37 am

I was saying this 20+ years ago. Truth is, the NHS management is happy for GPs to do all this, so long as they don’t expect payment, whereas 2y care can bill for everything. Stupid system. Glaed I’m out of it now.