On Sat, 27 Jul 1996, Antony Sumara wrote:
> Do you have any examples of secondary care being performed in primary
> care settings - best practice only please. I am the director of a
> primary care directorate of a combined community and acute trust and new
> to gp-uk.
There are many examples in Canada. In urban settings perhaps 30-40% of
G.P.'s do hospital work; in the country it must be close to 95%. This
would include medical admissions, obstetric deliveries, and working in
emergency, for some. In the country, all of this would be done. As we are
increasingly being "restructured" and there are fewer housestaff due to
cutbacks; the demand and responsibility is increasing.
G.P.'s are not happy, especially in the city. Many resent their totally
office-based colleagues who are better paid on (multiple) office-based
fee-for-service visits. This is leading to resignations from hospital
service, and I fear we will end more like the UK where ( I think ) there
is not a great deal of work in hospitals by G.P.'s. From what I have been
able to follow in the prostate exam debate, there may even be quite a
schism !
More recently there has been talk of 2ary care in the home with "hospital
in the Community" schemes ; we're supposed to supervise at home i.v.'s or
patients with DVT's etc. Unfortunately, we do not have what you do in
Britain, which is that the community Health Nurses and or Home Care nurses
actually confer with community G.P.'s in their offices.
When it works well it is good for the patient and the G.P.; there is
better continuity of care and job satisfaction. It is good to be able to
get out of the office and interact with specialist colleagues.
--Mark
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