Most GPS will be too busy to read or reply to Mr Darzi. As a retired GP I feel I have to reply. The letters from the Times’ replies are in the pdf below.
It seems a little ironic for a surgeon, who deals with operations and definitive outcomes, to comment on General Practice. The good GP uses time as a diagnostic tool, lives with uncertainty and handles patients with multiple symptoms and often multiple diagnoses.
Failure to train enough doctors is one problem. Training a disproportionate number of females to males is another. Making the job more and more desk bound and administrative is another. The shape of the job has changed a lot, but given time, appropriate training, and backup of a good team it would still attract. GPs need broader training especially so that all of them have the same opportunities in Paediatrics and Psychiatry, and Old age medicine and rehabilitation.
Doctors are trained to think laterally and make a diagnosis. The training takes a long time but why has only 2 out of 11 applicants been successful over the last two decades? Rationing places at medical school has now killed the goose that laid the golden eggs of efficiency. Nurses will probably refer more, request more tests, follow up more, and may well make more mistakes. The litigation will follow…
And will this mean that unpopular areas retain GPs, whilst unpopular ones have Nurse Practitioners? A health divide if ever there was one, and an encouragement for private practice.
Primary care and public health are becoming even more important as the population ages, diseases change and the need for long-term community care grows. Yet at the same time, this work is becoming increasingly unpopular with doctors.
To add to the problems of retaining GPs, a survey of general practice trainees carried out this summer by the King’s Fund, a health think tank, found that only a fifth planned to be working full-time a year after qualifying. The proportion planning to be working full-time after ten years was the same.
This is an astonishing vote of no confidence. Like many of their generation, young GPs want a portfolio career. They want to be involved in research and education; the prospect of owning and running the same practice for the next 30 years is a million miles from what most hope to do with their lives. They are not alone. Surveys show a similar trend across the world, with fewer than 10 per cent of physicians choosing family medicine in some countries.
Here, then, is an opportunity for nurses. Advanced practice nurses, also called nurse practitioners, are as effective as doctors at many tasks and, according to one study, could take on 70 per cent of GPs’ workload. Their main areas of expertise are in the management of long-term chronic conditions such as diabetes; they can diagnose, treat, prescribe and refer patients to hospital, and admit them if necessary. There are limits to their responsibilities (they don’t treat children under five or expectant mothers and they can’t sign sick notes) but they are acceptable to the public, take less time to train and cost less than GPs.
A report by a group of international experts, to be presented at the World Innovation Summit for Health in Doha next month, which I chair, will argue that nurses are poised to become the dominant force in primary care. They tend to live in the communities they serve, understand the local customs and culture and are well placed to detect early signs of disease and help tackle the wider social determinants of health.
There is a growing recognition that nurses are well suited to provide the sort of patient-centred care that is needed to look after the rising numbers of people with chronic diseases such as cancer, heart failure, diabetes and dementia.
There are barriers. Improved education, recruitment and commitment from employers will be required. But if we are to solve the crisis in primary care, we must urgently look to positioning nurses as the new gatekeepers of the NHS.
Professor Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London