Plan to farm out post-op checks to GPs unsafe, says top surgeon
Sarah Boseley
Guardian, Saturday December 30, 2006
The president of the Royal College of Surgeons today warns that
government plans to farm out the aftercare of surgical patients
to GPs are potentially unsafe.
Bernard Ribeiro, who still practises as a general surgeon, says
in a letter to the Guardian that the proposal is a cost-cutting
measure that puts patients at risk. The government wants to free
up surgeons by requiring GPs to see patients for the follow-up
checks now carried out by the surgeon responsible for the operation.
Mr Ribeiro says GPs are too busy and would have neither the
skills nor adequate knowledge of the case. "There is neither the
expertise nor the capacity to deal with this. It appears to be
attempting to move this work from surgeons trained in managing
these cases to GPs."
Basildon and Thurrock University hospital, Essex, where Mr
Ribeiro practises, has for the last three months invited GPs to
take back the patient after surgery. Only 24 patients out of
thousands went back to their GP rather than the surgeon's
outpatient clinic. Most GPs did not appear inclined to take on
the extra cases. "I don't believe there are enough GPs with
enough free time to sit around giving these patients advice,"
said Mr Ribeiro.
Mr Ribeiro is sceptical about government claims that the measure
would free up surgeons to carry out more operations. Surgeons
would still have to hold outpatient clinics, and since
consultations with new patients take longer than follow-ups, the
increase in surgery would not be great. He also questions
whether there will be enough theatre capacity and staff for more
operations.
Safety is the biggest issue, he says. There is no obvious way in
which the care of the patient will be improved if he or she is
seen by a GP. "If I'm treating a patient, I want to be in a
position to say to the patient your treatment is complete," he said.
He felt the measure had little to do with quality of care and
was perhaps prompted by government commitment to meeting its
waiting time targets for patients by increasing the number of
operations.
The proposal has been recommended by David Colin-Thome, the
national clinical director for primary care, whose report on
services will be published in January. Dr Colin-Thome says most
patients concerned about their recovery already see their GP
within two weeks of surgery, rather than waiting six weeks to
raise the problem with a consultant.
"The system needs a rethink," he said. "We waste consultants'
precious time and expertise if we force them to spend hours
simply telling patients they're recovering fine ... It is like
asking a Michelin-star chef to cook microwave meals all day."
"Patients don't need specialists to tell them they are fighting
fit. Most will know this themselves, and those who want extra
advice would get this from their GP."
http://www.guardian.co.uk/uk_news/story/0,,1980121,00.html
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