GPs surveyed on healthcare proposals

This is a copy of the letter sent to the British Medical Journal:

"Fit For The Future?

Proposed changes in the provision of healthcare throughout the country are providing the source of much debate.

Principal among these is the proposed role of the district general hospital within the secondary healthcare system with the onus appearing to be a downgrading or closure of many such hospitals.

This implies that either there is capacity within local hospital networks to absorb the current work or that primary care is both willing and able to provide extended services to prevent the need for much of secondary care.

This is said by the SHA to be both effective and achievable and in line with 'modern changes in healthcare'. We are consultants involved in acute medicine in West Sussex a part of the Kent, Surrey and Sussex Strategic Health Authority which has attracted considerable interest of late regarding the possible restructuring of services.

Not least among these are dramatic proposals in the reduction of workload from primary care, which we are assured are supported by colleagues in primary care.

In order to assess the genuine views of our primary care colleagues a simple survey was conducted to gauge the degree to which our colleagues felt that proposed changes could actually be instigated.

130 questionnaires were sent to all general practitioners registered in the Arun, Adur and Worthing district addressing both emergency and elective medical care.

86 replies were returned (66%) of which 2 were not completed and one practice of 6 partners felt that they could not comment.

This left a sample size of 78 general practitioners (60%). Based on proposals which had been made by the previous primary care trust (now of course restructured'¦) the following were asked.

1) Did our colleagues feel that a 20% reduction in emergency workload at the acute hospital (as proposed) was achievable without compromising clinical care in emergency general medicine, clinical haematology, cardiology, medical oncology, neurology, rheumatology and geriatric medicine?. Less than 10% felt that a 20% reduction was achievable and approaching 75% felt that no reductions at all were possible.

The results are shown in figure 1 together with percentage reductions thought feasible.

2) We asked if a 30% reduction (as proposed) in outpatient workload was achievable in the specialities mentioned plus gastroenterology, dermatology, respiratory medicine and nephrology.

Again 85% of the GP sample thought the proposals unrealistic within the current system. Interestingly, only 15% of GP's felt that a 30% reduction in dermatology outpatient referrals were possible despite this being an oft targeted area nationally (Figure 2).

3) We asked if the proposed 8% reduction in ICU admissions was believed to be possible: not a single GP responding felt that this was achievable.

4) Finally we asked whether the suggested 57% reduction in A&E admissions was believed to be possible. Only one GP of the sample of 78 thought this feasible.

This was a simple study to gauge the feelings of our local primary care practitioners towards the proposed changes which appear to being instituted as a matter of faith without any evidence base.

Clearly there is little confidence in the proposals among the GPs who will have to manage the referrals under the proposals.

No doubt significant investment may make some of these targets achievable but at what cost? Not only would this require financial outlay but would also be to the detriment of locally provided secondary care.

If the proposals were instituted a minority of patients would perhaps be better served with regard to 'care' being closer to home. The majority however would face longer journeys to larger secondary care centres and in emergency situations this could prove detrimental.

We thank our colleagues in West Sussex for taking the time to answer our questions.

Lui G Forni Consultant Intensivist & Physician

Mark Signy Consultant Cardiologist

Richard M Venn Consultant Intensivist & Anaesthetist

Worthing General Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH.

Competing interests: We work in the National Health service and wish to preserve its integrity.