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‘Glorified receptionists’? GPs’ gatekeeper role is crucial…

In the same vein as David Cameron’s comments about dinner party cliques or Professor Malcolm Grant's golf-playing jibe, it was a remark perfectly judged to outrage an entire profession.

'Little more than glorified receptionists' was how Times columnist Matthew Parris described GPs on Saturday, and the headline preceded some 1,200 words of scathing criticism:

We pay general practitioners more than we pay airline pilots, but they are becoming glorified gatekeepers: a portal to the more specialist medical care that our health service offers in growing measure. As GPs have receptionists, so the NHS itself uses GPs as its receptionists. Are we investing too much in the citizen’s first port of call, to the detriment of investment in the specialist attention to which, to an increasing degree, surgeries are likely to end up referring the patient?

I’m not denying that doctors work tirelessly or possess skills and learning that they’ve trained hard and long to acquire. Nor am I suggesting that GPs are anything other than dedicated professionals in whose opinion patients place trust and from whose care we get much needed reassurance. I’m simply asking whether the bulk of what they do actually requires the intervention of a Rolls-Royce of a medical professional at the citizen’s first sneeze. Is the work of these expensive and expensively trained men and women best directed to the point at which they’re doing it? Could we cut out the middle man?

Outrage among GPs was guaranteed, and instant. The medical section of Twitter exploded. Tower Hamlets GP Dr George Farrelly challenged Mr Parris to come and shadow him at work for a day. RCGP chair Dr Clare Gerada fired off a retort to the Times, and she is joined by several angry colleagues in the paper’s letters section today.

Some of this, of course, is part of the anti-GP rhetoric to be expected in the week doctors take industrial action for the first time since 1975. But Matthew Parris is no unthinking GP-knocker, and some of it, too, is grounded in genuine frustration around valid complaints – on access, continuity of care and the other usual suspects. There are real questions to be asked around skill mix, it is true. And whenever staunch defenders of the values of traditional general practice hear the complaint that 'we no longer expect to see the same GP every time, no expect doctors to know or remember much about us’, they must surely wince a little. 

But the crux of Mr Parris' argument - that patients would be better off cutting the middleman  and instead being triaged by (genuine) receptionists and seen straight in secondary care - is fundamentally flawed. 

For a start, of course, GPs are much more than a gateway to secondary care. Mr Parris may be fortunate enough to have correctly self-diagnosed before every GP visit, and to have only visited his surgery on average once every two years, but for many that isn't the case. Who would want to take that odd lump or persistent headache to a receptionist, and let them decide if you need further examination? And if you are unfortunate enough to suffer from a chronic long-term condition, GPs have a crucial, under-appreciated management role. 

And secondly, while GPs playing gatekeeper may be genuinely frustrating for those patients who know they require a certain prescription or referral to a particular specialty, that’s not really the point. The fundamental problem facing the NHS isn’t how to provide top quality specialist care, it's how to afford it - and it is here that the gatekeeper bit is essential. Generalism is a specialism in its own right, and GPs are uniquely placed and qualified to treat many patients, and safely and effectively triage the rest. 

If that makes then glorified receptionists - medically qualified, life-saving and cost-effective glorified receptionists - so be it. It's a badge they can wear with pride. 

Steve Nowottny is the acting editor of Pulse.