Leading article: A surgical solution


A report yesterday by Dr David Colin-Thome, the National Clinical Director for Primary Care, set out the next evolutionary step for the National Health Service. Dr Colin-Thome argued that general practitioners should work side by side with consultants in cottage hospitals and local health centres. Patients should attend medical "one-stop shops" where, as well as accessing all the usual GP services, they can undergo minor operations. In practice, this would mean instead of GPs referring patients to hospital for routine procedures such as the removal of cataracts or varicose veins, they would be treated in the surgery where they received their diagnosis.

It sounds radical, but Dr Colin-Thome is quite right. We need to get away from the idea, dating from the time when the NHS was founded, that an operation inevitably means a lengthy stay in hospital. The proposal makes financial sense. It has the potential to deliver considerable savings for the NHS by taking the pressure off hospitals. It would cut waiting lists and allow consultants to focus on specialist services. It would also serve as a disincentive for doctors to refer patients to hospital if they did not really need to be there.

The plan makes sense on medical grounds, too, as it will make hospitals safer places. At the moment many patients find themselves sent to these "palaces of disease" for routine operations. The more patients there are on a ward, the greater the risk of an outbreak of a "superbug", as cleaners and nurses find themselves over-stretched. And there is certainly no shortage of demand for a more decentralised service. Surveys consistently demonstrate that patients want health services to be delivered closer to their homes. Few people would choose to stay in hospital if they could be in and out of their local clinic on the same day.

The greatest obstacle to Dr Colin-Thome's vision is likely to come from doctors themselves. We can expect complaints that the scheme would cost too much and that the extra workload would be too much for doctors to bear. Such objections should not be allowed to stand in the way. The extra costs for the community operations would come out of the hospital budgets of the Primary Care Trusts. And when considering the inevitable workload objections, we should remember that in recent years many doctors have seen their pay increase by almost two thirds, and that GPs are no longer required to see patients at weekends.

Last week one of the doctors who negotiated the 2004 GPs' contract admitted to being "stunned" by the terms offered by the Government. Embracing this plan provides an excellent way for family doctors to justify their generous new contract.

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