Bruce Keogh’s first paragraph (The NHS rose to the challenge of Covid, but its next test may be even harder, 18 February) highlights a key barrier to NHS reform: the persistent undervaluing of general practice. The implication that GPs simply manage risk while patients wait to see “specialists” is not accurate and is representative of a recurrent problem.
GPs are specialists – specialists in general practice. General surgery is a surgical specialty, General Motors is a specialist transport company and General Electric is a specialist digital industrial company. Do not be confused by the semantics; Jessica Ennis-Hill is clearly a specialist athlete despite the fact she does not individually run the fastest, throw the furthest or jump the highest.
It is often quoted that GPs handle 90% of patient contact with the NHS, but it is rarely explained that they do this on an average budget of £155 per patient per year – £155 for unlimited specialist general practice is an absolute bargain. AI and genomic analysis may be the expensive cherry on the cake at some point, but they are unlikely to add much to the management of the mountain of complex comorbidity that GPs manage and is such a key challenge for the NHS – those aged 75 and above with heart failure, kidney failure, memory failure and (often) social circumstances failure.
Until general practice is appropriately valued and funded, reforms will continue to rearrange the deckchairs on the Titanic.
Dr Peter Thomson
GP, Bristol
