Radical Surgery for the NHS? What is a GP’s role today
Proposals in the recent Health Bill to change the role of GPs have been among the most contested of all the coalition’s policies. David Cameron cited GPs’ frustration with NHS bureaucrats as a core motivation for putting them in the driving seat, responsible for commissioning most healthcare and in charge of huge budgets. Yet while some rejoice at the prospect of the medical experts having a greater say in deciding how best to allocate resources, others worry GPs will see their professional authority undermined if they take on managerial roles on top of their medical responsibilities. Meanwhile, frontline healthcare is increasingly being provided by ‘nurse practitioners’ and call-centre surgeries such as NHS Direct; even pharmacists now provide vaccinations and routine health checks.
Whatever happens to the current Health Bill proposals, there is little doubt the role of doctors has been changing for some time. The increasing focus on public health and preventative medicine means GPs are no longer asked simply to treat sickness, but to help prevent healthy patients getting ill in the first place. Patients’ diet, alcohol intake, smoking habits, weight and level of exercise are now considered to be doctors’ main focus, to the extent that recent NICE proposals could see GPs paid more depending on how many patients they encourage to stop smoking. Some surgeries are now setting up shop in supermarkets to attract doctor-shy shoppers and foster greater public awareness of healthy living. At the same time, the ever-greater scope of the Quality and Outcomes Framework means GPs are required to probe ever deeper into patients’ health and lifestyles beyond their reported illness.
Have these changes really been thought through and debated sufficiently by doctors, or simply nodded through with a shrug? Are the new roles empowering or, as the Kings’ Fund suggested in 2010, has the medical profession has lost confidence in itself? Are GPs undermining the doctor-patient relationship by trespassing into lifestyle areas previously considered private? Why have GPs’ roles become such a political issue? How much does it have to do with current economic uncertainties and public sector cuts? Are doctors being turned into bureaucrats, rather than liberated to get on with their medical responsibilities?
Brid Hehir will be introducing the discussion. Until recently, Brid has spent a long career in the NHS. She has been a nurse, midwife, heath visitor and senior manager, and remains a regular contributor to the nursing press.
Improving the quality of care in general practice Kings Fund, March/April 2011
David Cameron reveals GP frustration inspired Health Bill, Neil Durham, GP, 27 January 2011
For ‘Liberating the NHS’ read ‘Dismantling the NHS, Clive Peedell, NHSCA, 4 Jan 2011
Understanding the doctors of tomorrow, Kings Fund, 2010
What makes a good doctor? The start of a national conversation, GMC, Feb 2011
Time for NHS to act after pause, says Andrew Lansley, Guardian, 8 July 2011
It’s unethical for general practitioners to be commissioners, Mark Sheehan, BMJ, 10 March 2011
NHS reforms could reduce patients’ trust in doctors, BMA warns,Rajeev Syal, Guardian, 27 June 2011
Supermarket surgeries give GPs a new way to reach patients, PULSE, 6 July 2011
The BMA: modern-day prohibitionists, Max Klinger, spiked, July 2011
GPs agree ban on operations for smokers and obese patients PULSE, 19 July 2011
QOF targets must not be outside GP control, Tom Moberly, GP, 24 January 2011
Doctors can promote fairness and equality in health through education, Bob Davidson, Total Health, June 2010
Questions to Roy Lilley, OnMedica, 10 May 2011