DISINTEGRATING CARE - OR THE VALE OF TEARS

By Patrick Trust
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

What's a Doc to do when all around are losing local care? If you can't beat 'em join 'em - so I joined the local Hospital Action Forum and marched with 4000 other patients to link arms around our local hospital, and it was an impressive demonstration of patients’ wishes to retain a local care facility threatened by the Clinical Strategy review of NHS Argyll & Clyde. We have already lost Obstetrics, A&E, Emergency Surgery and some Lab services and the Anaesthetists want to go next with the rest of the labs close behind if the NHS Board gets its way.

Centralisation is seen by many consultants as the only way forward with junior doctors hours and a new contract of their own. Patients on the other hand want their local services to stay put whilst realising that you cannot have a neurosurgeon and cancer specialist at every GP surgery. So when two apparently irreconcilable motions come together the pragmatist will look for the 'Third Way' or a GP will seek the sensible middle ground solution. Much is made of GP 'Intermediate Care' but our local professionals feel that 'Integrated Care' is the only way forward for our area. Integrated means a true working together of Primary and Secondary Care to provide a SAFE and SUSTAINABLE service. It is encouraging to see a local group of health professionals coming together to design an integrated service. This however will require Board and National support for the training of 'Integrated Care Physicians' and the development of Clinical Nurse Specialists along with Hospital at Night models. Surgeons are increasingly returning to our local ex-DGH as it becomes clear that the central hospital is full to bursting with all the emergency work. Integrated Care can allow the surgeon to carry on operating on low risk elective cases but not be on call in the hospital overnight, or at the weekend.

At a recent conference on Integrated Care at the Royal College of Physicians in Edinburgh it was acknowledged that generalists were still needed in Scotland. Thus training programmes will require to be designed to reflect this. So how should a GP respond to all this centralisation from the top? As a pragmatist who trained as a general physician, but wisely transferred my affections to General Practice, I believe a bottom up solution will be beneficial for my patients. I suspect the solution will differ according to the local prevailing situation, but the generalist must be reborn as part of a team to provide a safe and sustainable local service. There are not sufficient numbers of doctors and nurses to allow Primary and Secondary Care to carry on in parallel - so Integrated Care is the sensible solution combining forces to cover local care needs. However there is so much to take on with the new GP contract, Community Health Partnerships , Kerr and Kerr, and the Scottish Parliament Health Committee Report to mention a few. So GPs, Consultants, Nurses and AHPs must work together to provide what patients demand - a local service for the majority of medical care.

Other hoolet online articles by Patrick Trust can be found at:
hoolet edition 44 - Vale of Tears
hoolet edition 41 - Glasgow Gals - Sex, Alcohol and Religion

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.