Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Secondary care is not evil
- Nigel DC Sturrock (10 February 2006)
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Unfettered Secondary care Growth is sucking NHS Dry
- John S Ashcroft (24 February 2006)
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Integrate education and training in new models of primary care
- Mayur Lakhani, Arthur Hibble, Bill Reith (27 February 2006)
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Nigel DC Sturrock, Clinical Director Acute Medicine Nottingham City Hospital NG5 1PB
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Whilst secondary care has come to expect hospital and consultant bashing as a Government pastime, it is disappointing that the BMJ, under this editorial follows the party line. It is not secondary care that drives unscheduled activity but patients. Hospitals are not "sucking" funds from primary care in some grotesque saprophytic manner. Indeed the opposite is true in practice. Secondary care Trusts, through emergency care networks, have been attempting a variety of admission avoidance strategies to reduce the excessive demands placed on emergency admissions areas and A&E's. The "NHS in England Operating Framework 2006/7" sets a differential PbR tariff for emergency care above 2004/5 (+3.2%) levels of only 50%. Not only will PCT's and the government get emergency care on the cheap, but this editorial implicitly suggests that secondary care Trusts should indeed be being punished in this way for meeting the demands that patients and primary care place on them. Apparently, like leeches secondary care have been looking for "financial incentive(s)...to increase emergency admissions"! I believe that the NHS is on the critical list and am becoming disillusioned by the lack of understanding that the DoH has with regard to provision of patient care and services. The privatisation of primary care and elective care will leave the expensive care for complicated patients to hospitals that have been financially starved and downsized, but by that stage they will be incapable of providing such services. Competing interests: None declared |
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John S Ashcroft, General Practitioner,Vice Chair Erewash PCT, Deputy Chair Derbyshire LMC Old Station Surgery,Heanor Rd, Ilkeston,Derbyshire DE78ES
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Dear Sirs, The White Paper is, of course, worthy but certainly impossible to implement. Already the new GP contract changes have shown that quite simply the Department of Health and management structures of the NHS do not understand general practice or what it is capable of. GPs embraced the concept of quality and because of the delay in the contract essentially put two years’ work into the first year’s results. The Department of Health appears mortified that GPs did better than expected with resulting contract changes increasing the volume of work by 15%, the work made harder - all this for a pay cut. Primary care has been starved of funds for decades and there continues to be a widespread lack of appreciation to just how much money and resource has gone into hospitals and how little into primary care. Since 1994 the number of GPs has gone up by just 10% (2772 Whole Time Equivalents) - barely adequate to meet the over two million rise in UK population. Consultant numbers have risen by 76%, hospital training grades by over 55%; for every extra GP there have been nine hospital doctors, more than four of them consultants. But, as Dr Nigel Sturrock’s response exemplifies, the secondary care sector still feels that primary care has had too much. As the Vice Chair of a PCT that contracts extensively with Dr Sturrock’s hospital, I have even seen monies ring fenced for the modernisation of general practice under the new contract moved by financial spreadsheet “management” into his hospital coffers. Let me reassure him - hospitals really have “had it all”. Competing interests: General Practitioner in NHS |
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Mayur Lakhani, Chairman RCGP, SW7 1PU, Arthur Hibble, Bill Reith
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Further to Richard Lewis’s1 editorial on the new health and social care white paper, Our Health, Our Care Our Say2, we would like to highlight its implications for education and training in primary care. We want to do this because we are becoming increasingly concerned that education and training seem to be moving lower down the agenda at a time of major reorganisation and financial constraint in the NHS. New developments in primary care will result in a greater need for training capacity, not less. The White Paper is likely to lead to major changes in the way general practice is organised because of plurality of provision and practice based commissioning. It is essential that arrangements for education and training are built into the new models for primary care at the outset and that lessons are learnt from experience in secondary care where there were concerns about loss of training opportunities when Independent Sector Treatment Centres (ISTC) were first established3 The crucial role undertaken by general practice in education and training is often not recognised outwith the specialty. General practice contributes a significant proportion of the undergraduate medical curriculum and over one third of practices are involved in teaching undergraduate medical students. There are over 3600 general practitioners who are approved as trainers for specialist training for general practice. These figures demonstrate great enthusiasm for teaching and training within general practice. However, there is also frustration. There are reports of a lack of funded training places to meet demand from young doctors keen to train in the specialty. In addition, a lack of resource for developing premises has resulted in difficulties providing adequate, fit for purpose accommodation. New models of primary care offer a rich base for developing innovative solutions for teaching and training the future NHS workforce – not only doctors and nurses but also a whole range of support roles. In these new models it seems likely that specialists and generalists4 will be working together much more, further increasing the potential for innovation. We would urge strategic health authorities and commissioners to consider the education and training implications of the White Paper as part of their duty of care to tomorrow’s patients. They should use the new freedoms and powers to bring about a much needed major expansion of teaching and training capacity in primary care. Dr Mayur Lakhani
Dr Arthur Hibble
Dr Bill Reith
RCGP London SW7 1PU Competing interests: The RCGP recommends standards for GP training and COGPED is responsible for the implementation of GP training programmes. References 1 Lewis RQ. A new direction for NHS community services. BMJ 2006; 332:315- 316 2 Secretary of State for Health. Our health, our care, our say: a new direction for community services. Norwich: HMSO, 2006. (Cm 6737.) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/WhitePapers/fs/en?CONTENT_ID=4122399&chk=JgwlAS (accessed 26th Feb 2006). 3. http://www.bma.org.uk/ap.nsf/Content/HealthCommitteeInquiryintoISTCSubISTCs (accessed 26th February 2006) 4 http://www.rcgp.org.uk/default.aspx?page=3671 (accessed 26th February 2006) - Joint Statement from the Royal College of General Practitioners and Royal College of Physicians Competing interests: The RCGP recommends standards for GP training and COGPED is responsible for the running of GP training schemes |
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