Being a ‘generalist and gatekeeper’ is no longer sustainable for a GP | Zara Aziz | Society | The Guardian

Increased patient demand means GPs require training focusing on key specialties needed in the community, such as dermatology, palliative care and psychiatry

I always wanted to be a GP. The idea of traditional family doctor-something out of Dr Finlay’s Casebook appealed to me. But my early years as a generalist had their own uncertainties. As a trainee, I would be filled with trepidation in case the next patient had a condition I knew nothing about. I had done two years of standard hospital posts before joining a pleasant rural practice, with its caseload of the “worried well” and “expert” patients. Five years after qualifying from medical school, I had experienced a steep learning curve.

 

GP training has hardly changed since I qualified in 2007 and is shorter than all other UK surgical or medical specialties. But primary care is very different from even a few years ago. Monitoring and target-setting by clinical commissioning groups (CCGs) and unprecedented demand on hospitals means GPs are increasingly being asked to do work that is not resourced. The

 

Our referral rates are scrutinised at CCG levels to identify outliers, especially in overstretched hospital specialties. In general, non-urgent consultant-to-consultant referrals are no longer carried out, and this means patients are referred back to their GP. Hospitals are no longer paid for consultant-to-consultant referrals, but only for the problem for which the patient was referred. This change has been implemented by CCGs and creates unnecessary delay, as the patient is going back and forth between GP and hospital.

 

For example, I refer David to the eye hospital for a red eye and cloudy vision. He is diagnosed with a condition called uveitis (inflammation in the middle layers of the eye) and started on treatment. At his review appointment some months later, his specialist notes that he has inflamed joints and writes back to me to request a rheumatology opinion. There is a delay in the arrival and actioning of the letter. The subsequent referral is made several weeks later, which adds even more time to the existing wait for his rheumatology outpatient appointment.

 

, we are managing more complex patients in the community. Early hospital discharges mean there are more sick people with respiratory failure, complex diabetes, kidney disease or mental health problems. It is often difficult to get a second opinion for these patients, as hospitals face their own pressures. I can get telephone advice for a very unwell patient with multiple sclerosis but there is no hospital bed available, and my frequent visits are no substitute for specialist inpatient care.

 

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