> Reminds me of the cardiologist who (many years ago) asserted at a GP
meeting that all new hypertensives should have an IVP - he was offended by
the muffled chuckling in the audience. Clearly had no idea of the
scale of the problem or the number of patients in that specialty that did
not rear their heads above the parapet of general practice. [Jel]

Your analogy is off the mark, Jel (and Robbie), I hardly think late injuries
take up such a huge proportion of GPs' workload, to the extent that A&E
departments will become "swamped" if GPs suddenly stop dealing with them,
despite Robbie's estimates! Well, perhaps they do for certain GPs in certain
parts of the country, Robbie, but not around here. Besides, as Bill points
out, we already see all of the area's primary care during the holidays, and
that doesn't amount to 750 per day! So I hardly think we'll be swamped by
our local GPs' injury cases, certainly not in my neck of the woods. But my
point was really about 48-hour cut offs, particularly with respect to
wounds, fractures and head injuries. I'm pretty sure they all get sent up
here anyway!

> What is this tirade about? You provide care, I provide care, they provide
care - none of us do all of it.

That was called heavy sarcasm, Jel! It was in response to you enlightening
us with your definition of primary care, and implying that injury management
was included therein which somehow justified primary care's claim to injury
management. My point is, just because injury management may fall somewhere
within "undifferentiated by age, gender, disease or organ system...not
limited by problem origin (biological, behavioural or social), organ system,
or diagnosis!" does not somehow mean that general practice has the
infrastructure to take on injury management i.e. there's a big difference
between philosophical definitions and reality. And the harsh reality is
sitting in my department waiting room right now at 5.00am! Joe Public isn't
very philosophical either, and he clearly doesn't realise his GP can look
after his injuries (sorry, more sarcasm, but you drive me to it!).

But at the end of the day, Jel, GPs currently have a choice about it, and
injury management is still not a core part of their remit. As Robbie himself
stated "My job is PRIMARY CARE. That means I get to lay claim to whatever I
like, so long as it comes to me first." Please particularly note the words
"lay claim" and "whatever I like", which says it all really, and from
October you could add to that list "whenever I like". That's all very well,
it's nice to have your special interests (in office hours), but WE don't get
a choice in the matter, and WE have to take the left over primary care as
well. We HAVE TO provide an injury service 24/7, like it or not. All I was
arguing is that it would be crazy to make injury management a core part of
GPs' duties, given the severe underresourcing of general practice
particularly in the inner cities, just because some of you do a lot of
injury work. By all means keep it as an option for certain GPs in certain
areas, but I wouldn't want to see late injuries redirected from A&E
departments because some boffin thinks that 48 hours somehow transforms how
we manage them. That's what I mean by politically driven, as there would
appear to be no medical input here, and the figure of 48 hours was clearly
dreamt up by some academic. Someone probably figured that redirecting these
patients to primary care will improve our 4-hour targets, that's what I
really think...

I have absolutely no doubts that there are individual GPs around the
country, and particularly on this List, who are highly experienced in trauma
management (and who do so out of hours!), but they are the exception,
particularly in the inner cities. I just wouldn't want their enthusiasm for
minor injury management to completely screw up the system for the vast
majority of GPs (who don't care for minor injuries) and their local A&E
departments.

Adrian Fogarty