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GPs should give up their gatekeeping role

In the past week, it has transpired that 100 practices a year are applying to close their lists and 40% of GPs are to quit in the next five years. We all know that the workforce crisis in general practice has now reached tipping point. We know recruitment of new GPs won’t happen in time, even if the current recruitment drive is successful. We know that with pensions being eroded and workload escalating, there’s little to tempt retiring GPs to delay. It’s time for a much more radical look at reducing demand on general practice.

I get frustrated every time I hear the president of the Royal College of Emergency Medicine on the news complaining about how busy their departments are. His comments are newsworthy because he appears when it has been a bad week or month. Maureen Baker would have to be on the news every day if the situation in general practice was to be similarly reported. What irks me most is that the answer to the A&E crises is always ‘GPs should be seeing more patients’. That is not the solution.

Patients with suspected fractures should go to A&E, not their GP. Patients with haematemesis should go to A&E, not their GP. But I think we can extend this principle even further. Yes, I am calling for the (partial) end of the GP’s gatekeeper role.

Giving up the gatekeeping role could be the price which saves general practice

There are clear situations where a GP’s role is simply to redirect an informed patient to the specialty they require. If there is a national screening programme, then adverts should not direct concerned patients to their GP. They should be directed to a national number which will feed them into local screening clinics run by Public Health England. This is currently how the abdominal aortic aneurysm screening programme works – concerned patients ring and book an appointment themselves.

Similarly, diabetic patients should be able to book directly with NHS podiatrists if they have problems with their feet. Postmenopausal women who experience vaginal bleeding should be able to book directly with a gynaecology service. Women over a certain age with a breast lump should be able to book directly with a breast clinic. There are many situations where there is a clear need for a specialist opinion.

Already the technology exists to support this. NHS Choices and 111 could easily be enhanced to link with Choose & Book, local pharmacies, podiatrists, optometrists and physiotherapists. There are increasing numbers of solutions for GP practices to use to signpost their patients rather than book a GP appointment. These should be rolled out and funded nationally.

Ultimately, GPs are best at assessing and managing complex multimorbid patients. No longer can we afford to waste our time redirecting otherwise healthy patients to another professional. Giving up the gatekeeping role could be the price which saves general practice.

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative

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