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?