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Is the family doctor a dead man walking?

I chaired and spoke at three conferences two weeks ago, and left very troubled. At one conference in London, where I described the pressures on general practice, I was challenged by an 80 year old, who said that he had an excellent service from ‘his personal doctor’. I asked the audience how many thought that they had access, as necessary, to a person they could call ‘their doctor’. Four put up their hands. I then asked how many would like to have someone that they could call ‘their family doctor’ and almost all the room put up their hands. The following day, I was speaking at the Primary Care Conference in Birmingham and asked the same question to the 350 GPs present. ‘How many of you,’ I asked, ‘would like to be able to offer patients a service that saw you as “their doctor” providing personal and continuing care?’. Around 80% put up their hands. I then asked how many were able to provide such care at present and barely ten raised their hands.

This is the biggest issue in general practice and should be a major general election issue. That is because England is on the verge of losing its ‘family doctors’, providing personal and continuing care to their patients. That is of concern not only to patients over 65 and those with long term or serious disease, who are known to want to have a personal advocate and an accountable doctor. It is what keeps patients out of hospital, reduces prescribing costs and frequency of attendance and made British general practice the envy of the western world. So why are we ditching ‘The family doctor’?

Some say it is a plot to break the current model of general practice. For my own money, it is simply because too many at the centre simply don’t understand what general practice does. They see GPs as generalists – jack of all trades – that can man the frontline of the health service offering a ‘doc in a box’ service that will filter admissions to hospital 7/7. The opposite is the case – impersonal care by ‘any old doc’ is expensive, duplicative and unsustainable. The current imperative of ‘access, access, access’– to any old GP doc – means that GP practices are now frontloading a massively increasing instant demand for ‘a doc’ and thus unable to offer access within sufficient time to a ‘doctor of your choice’. It has become an ‘either/or’ issue.

After 35 years of being ‘educated’ by my patients, I think I do know what they really want. Firstly, they want access within a week or so to a doctor to whom they can relate and, ideally, whom they regard as ‘their family doctor’. Otherwise and out of hours and weekends, they simply want rapid access to a doctor that can treat their urgent problem efficiently and effectively. Providing a 7/7 routine appointment ‘doc in a box’ service is not cost efficient or likely to reduce secondary care demand. Demanding it is likely to lead to more early GP retirements and a drying up of the dwindling number of doctors that want to become GPs. Patients and the public now need an open and honest debate on what they want, which includes the checks and balances of what they can afford within current means.

Incidentally, I asked that conference in Birmingham whether any had yet seen benefits from the GP Forward View. Disappointingly, of 350 GPs, none said that they had.

Dr Michael Dixon is a GP in Devon and former chair of the NHS Alliance