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Thursday, June 24, 1999 Published at 13:01 GMT 14:01 UK


Threat to 'immensely precious' service

Dr John Chisholm fears for the future of the family doctor

Government initiatives like walk-in centres for patients are threatening the future role of the traditional family doctor, warns the British Medical Association (BMA).

The association's GPs launched a series of scathing attacks on government health policy during their annual conference.

Dr John Chisholm, chairman of the GP's Committee, said that innovations like the NHS Direct telephone helpline, and walk-in "instant treatment" centres for patients could wreck a system that was "immensely precious" to both doctors and patients.

He said: "The huge investment in NHS Direct and so-called fast services diverts scarce NHS resources from the urgent and serious to the relatively trivial.

"Walk-in centres risk threatening the doctor-patient relationship, the link between patients and their local practice."

He warned that patients might not be able in future to ring up the surgery for an appointment, but would have to contact the helpline for advice instead.

Other GPs backed him, expressing their worries that the advantages of being treated by a doctor who knows your medical background could be lost.

'Russian style' clinics

Dr Peter Skolar, a family doctor from London, said that unless GPs fought to protect their traditional role, the future would be one of impersonal "Russian-style clinics".

"That's not a prospect I want to see," he said. "What patients want to see is continuity of care. Patients like their GPs and like being registered to a GP."

GPs, unlike hospital doctors, are currently not paid a salary, but employed by the health service as independent contractors, and paid by a complex formula based partly on the number of patients for which they are responsible.

Some fear that this traditional independence will be lost and replaced by a salaried GP service.

Open all hours medical service

The government's proposals involve high street and shopping centre clinics, open from 7am to 10pm, staffed by salaried doctors and nurses offering advice and treatment for minor conditions to all comers.

It is spending £30m to create 20 pilot centres.

Dr Chisholm accused the government of "gambling millions" on an unproven idea.

[ image: Patients will be able to consult trained nurses by phone]
Patients will be able to consult trained nurses by phone
The government responded by saying that the walk-in centres would complement rather than compete with family doctors.

A spokesman said:"The family doctor service is enormously important as the gatekeeper to the health service and walk-in centres are not intended to replace this."

The conference also roundly attacked other reforms to the health service, including the decision to gather all the doctors, practice nurses and community health workers in one area into a group with a combined budget.

But the groups have different responsibilities and powers in each of the four home nations.

These regional variations were fragmenting the National Health Service, the conference decided.

Dr Robert Liddell, from Grampian, called this an "assualt" on general practice itself.

He said: "General practice is being softened up and we are in danger of being picked off."

The conference supported a motion deploring the "fragmentation" of general practice through the reforms.

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