WRITING as a retired Weymouth GP, I am concerned about the proposal for polyclinics.
I have been surprised how many people have been voicing their worries to me over the idea.
As a family doctor I experienced many times when patients would appear for a trivial matter - perhaps wax in ears - which normally the nurse would treat.
However once they were ready to leave they would turn round, and say whilst I am here doctor, have I a lump in my breast' or I get this chest pain walking up slopes, do you think I should do anything?'.
Of course this was the real reason they came, not the excuse; but they would not have dared to say I hope I have not got cancer of the breast', etc. To a strange doctor, they would certainly not have dared waste his valuable time, but were at ease with someone they knew.
Patients' worries and illnesses are personal, and a general practitioner develops a skill in diagnosing the real symptoms, and the underlying worries.
I am sure Lord Darzi means well, but by the time he sees patients they are known to have a surgical condition meriting his expertise, not an unvoiced worry about a possible serious condition.
The recent evaluation of the NHS Direct telephone service revealed that more than 80 per cent of telephone consultations resulted in patients being told to go to the A&E department anyway - it was an expensive, worthless, exercise.
Polyclinics will be worse - there will be a delay in patients attending for potentially serious conditions; morbidity and mortality will rise.
Small practices are often staffed by mavericks', which I admit can be bad as well as good. However single-handed GPs have been responsible for several penny dropping' discoveries, such as vaccination against smallpox, infectivity of epidemic jaundice and the relationship between raised blood pressure and strokes.
Yes, the full research and evaluation is performed in University Primary Care research departments, but the initial idea is often evaluated in a small practice (much initial work on computers in general practice was performed in a small Weymouth practice).
Polyclinics, with transitory patient contact, will reduce the progress of primary care, and stifle innovation.
Yes, I appreciate that changes in society now preclude doctors from working from 8am to 8pm and subsequently being on call every night - my lot when I started.
No wife would allow it - nor would she sweep the surgery, waiting room (parts of the house), as in the early 1960s. Then the average working man worked from 7.30am until 6pm and finished at 1pm on Saturdays, but not now.
Indeed that is the reason patients can see their GPs at convenient times - working hours are shorter.
Yes, it may be easy to demonstrate that in the short term statistics can show theoretical advantages, but in the long run both patients and progress in medicine, will suffer.
Michael Watson, Buxton Road, Weymouth.
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