December Focus

[摘要] The Department of Health for England is preparing a White Paper for primary care. (Once again we must apologise to non-UK readers for the way that the UK agenda can take over the BJGP.) The Royal College of General Practitioners has responded very positively, trying both to gather ideas from members and the public, and to lobby members of parliament. On page 907 Mayur Lakhani summarises the results of this consultation. As one would expect, the voice of general practice is that we still have an important part to play in the UK's health services, and the Department should both recognise that and give us the support we need to carry on doing so, while we continue to respond to changing health needs, technologies and patient demands. He also recognises some of the threats, most obviously the Department's preoccupation with markets, and its almost religious faith in the need to introduce competition. Then there are the vexed matters of access and opening hours. Undaunted by the results of the last attempt to improve matters by introducing ‘Advanced Access’, with its disastrous consequences, the Secretary of State has now, according to my Guardian of Friday 11 November, decided that practices must stay open 8am till 8pm and at weekends. Set aside, for the moment, the mixed message — GPs in the UK have only just been relieved of the contractual obligation of 24-hour responsibility (I suppose one way of easing the difficulties of providing out-of-hours cover is to redefine out-of-hours). On page 973 Mike Fitzpatrick explains where these ideas arise. In all the discussions that are to come, we need to keep reminding the policy makers that the primary purpose of the NHS is to look after sick people, and only secondarily those well enough to be at work. To anyone who asks why we can't operate round the clock like supermarkets, the obvious answers are: that we are looking after frightened, sick people who often don't know what they need (not like supermarket shoppers at all); that what we are doing is something much more complex than selling food; and that if the supermarkets are so wonderful, where is this obesity coming from that we are having to deal with? Or this: what we offer is something personal, highly skilled and very precious; that it is to be valued enough to take time to use it appropriately; and that if our patients don't understand that then we shall have failed.

[学科分类] 卫生学