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18-09-2011 | Article

The rocky road ahead – Part 2

In the last editorial, I commented on the cuts and improved efficiencies expected from the NHS, and the theme continues this week. According to a univadis GP News item (click here), the savings generated from the NHS reforms will be less than anticipated. Bearing in mind that the plan is to make big savings in the NHS budget, a dent in this figure could have repercussions for future service delivery.

Naturally, the politicians put a gloss on this and, as quoted in the GP News article, the Health Secretary Andrew Lansley stated: "We are cutting waste and are still on track to reduce administrative spend by a third. Every penny saved will be reinvested into patient care, delivering significant long-term benefits to patients."

This sounds good on paper but will it work in practice?

The same article also reported a survey by the medical magazine Pulse, which implied that GPs are being restricted in their access to certain treatments. Of course this may not necessarily be related to the NHS reforms and efficiency savings. Even so, it is a worrying trend.

Another article published in Pulse magazine (click here) describes how private providers looking to muscle in on the NHS market are planning to replace GPs with nurses, and other "equivalent" healthcare professionals, to manage some conditions. I am sure this will work for simple, straightforward clinical cases. But many people presenting in primary care do not have simple, straightforward problems, and they require the skill, training and experience of a GP.

Of course, we are biased when it comes to defending our jobs. And of course there is room for more active involvement from other healthcare professionals at the frontline of primary care. However, I would argue that we still need a healthy involvement from qualified and trained GPs. But when money is tight, there is a temptation to squeeze as many savings as possible out of the NHS's enormous budget.

I ask again: where is the solid evidence base for such a policy as replacing GPs with nurses, and has it been fully trialled? GPs do not have a monopoly on primary health care but we are still an essential part of the primary healthcare team. Furthermore, I still think we provide a cost-effective and efficient service.

Even so, we must not rest on our laurels: money is tight, cuts will come and nobody is safe in their jobs - and that includes GPs for certain.

Best wishes,


Dr Harry Brown, editor-in-chief univadis

By Dr Harry Brown