Description

Navigating the stormy NHSeas was the title for this years CME ENT
update conference in London. Traditionally aimed at a secondary care
audience, I was interested to see a significant proportion of primary care
issues on the agenda. Practice based commissioning in particular, remains a hot topic,
and one that many consultant colleagues are struggling to understand and accept. In
certain parts of the country, specialist services, originally commissioned by the
Primary Care Trusts (PCTs), are now being handed over to local groups of GP
practices to manage and deal with. In an attempt to develop new and more patient
centred services, the Department of Health believe that primary care practitioners are
better placed to do this. It is not surprising that general practitioners with special
interests have a key role to play.

But has the balance of power shifted too much towards primary care? What of our
secondary care colleagues? How much have they been included in the recent
discussions and changes? What will become of their services as workf low may be
diverted elsewhere? As a GP, it may feel good to be more in the driving seat for once,
although have we really thought about the implications both to our secondary care
colleagues and to our profession in the longer term? In a paper by The Department of
Health and Royal College of General Practitioners, they state General Practitioners
with special interests supplement their important generalist role by delivering a high
quality, improved access service to meet the needs of a single PCT or group of PCTs.
They do not offer a full consultant service and will not replace consultants or interfere
with access to consultants by local general practitioners. 1 There are some who would
dispute that access to consultants will not be interfered with, and that patients are really
getting less choice as to who they will see, not more..

At a time when nurses and other non-medically qualified staff are being trained up to
carry out various procedures previously only performed by doctors, we see that the
boundaries between primary and secondary care are also being broken down and
levelled. This must feel uncomfortable for some, but as a caring profession we should
try to make this transition as smooth as possible. Communication is essential. And
perhaps we should bear in mind that most things have an expiry date. Local
commissioning will no doubt be replaced by something else eventually. It may be 2
years, it may be 20 years, but whenever it is, it is important to have the profession as a
whole on side..