Dorrell offers to ease heavy workload of family doctors

NICHOLAS TIMMINS

Public Policy Editor

A radically revamped role for family doctors, providing more of the care traditionally provided in hospitals while nurses and others take on more of the routine work in GPs' surgeries, was offered to general practitioners yesterday by Stephen Dorrell, the Secretary of State for Health.

What amounts to a new vision of general practice and which will almost certainly involve a new contract for GPs was outlined by Mr Dorrell in his first formal meeting with the British Medical Association's family doctors committee.

With both medicine changing fast and new purchasing arrangements breaking down traditional barriers between hospital and GP services, Mr Dorrell said before the meeting that there was "a huge opportunity to improve the quality of service to patients and make work more rewarding for staff in the medical profession".

He had, he stressed, an "open agenda" to which family doctors themselves were welcome to contribute. But he cited GPs becoming more involved in providing minor accident and emergency services outside hospital, in mental health services, in providing post-operative care in community hospitals or "hospital-at-home" schemes, and in providing on-going treatment not just for asthma or diabetes but other conditions, working under protocols designed by consultants.

In turn, nurses in general practice could probably prescribe for more conditions, operating within protocols designed by GPs. "These developments will have both resource implications and implications for who does what in primary care," he said.

He stressed that if GPs were being asked to do more, in some areas they would have to do less. Attempting to assuage GPs' fears that he is merely adding to a workload which they already see as excessive, he promised "reasonable rewards for reasonable workload", adding: "I do not think GPs have anything to fear from this. Absolutely the contrary."

It should, he said, provide a more rewarding job, freeing GPs to provide more time for the more difficult cases.

Following the meeting, a spokesman for the BMA said the committee "was impressed by Mr Dorrell's constructive approach to general practice", while expressing scepticism that the resources would be made available to allow the change.

With GP leaders agitating for a new contract to replace the much-resented one that Kenneth Clarke, when Secretary of State for Health, imposed on them in 1988, Mr Dorrell said he hoped to agree a set of objectives by early summer.

Detailed talks could then begin - a timetable that could see a Labour government having to settle the final package.

Although ideas for the new service are initially being explored with GPs, Mr Dorrell acknowledged the implications for nurses and others. "It is important to know how different professions react to the ideas. We want to hear what they say and get a clearer idea of where the emphasis should be."