Abstract
As another older general practitioner, I entirely agree with James Cave 1 and his concerns about the current state of the primary care workforce. The increasing reliance on newer team members, including paramedics, reflects the paucity of GPs, the escalating demands of an ageing and growing population and the failure of secondary care to keep pace with waiting lists. A referral letter does not equal treatment.
In fact, the fundamental ‘GP–Patient' relationship has not changed so very much: patients still seek quick access for a diagnosis, treatment, sometimes referrals and often just advice and reassurance. Perhaps the major change has been the interface between primary and secondary care where more patients with more pathology wait longer for hospital procedures and are discharged much sooner following admissions. Meanwhile, primary care takes up the inevitable slack in the system and remains the obvious ‘go to' choice for any and every variety of ailments known to effect humankind. While that remains the challenge and thrill of general practice, 10-minute consultations become a veritable minefield increasingly relying on experience and intuition as well as sharp clinical skills. Financially driven attempts to restrict GPs referring to hospital services have also placed a greater burden on community resources and have ultimately led to further despondency among a dwindling number of hard-pressed GPs. Finally, as Cave intimated, GPs have become the house officers of the NHS.