I understand and agree with many points raised by Prof Alan Walker (Letters, 4 July). But I do take issue with his statement on multimorbidity: “No one is focusing on the ways in which the conditions and the drugs interact.” This should be (and I believe was) the duty of colleagues in primary care, ie GPs. They must have no hesitation in questioning and, if necessary, modifying, the advice and medication given by those working in secondary care if it is in the interest of the patient. This requires cooperation and mutual respect between GPs and specialists.
The division and occasional friction that has arisen between primary and secondary care in recent years is in part due to the increased demands on hospital services that general practice has been unable to meet. This may well be due, at least in part, to the diversion of time and resources toward the prevention and early detection of chronic diseases mandated by the quality and outcomes framework, part of the general medical services contract of 2004.
While agreeing with Prof Walker on the importance of preventive medicine, we should realise that prevention can also be an escalating drain on resources. The onset of diabetes, hypertension and some cancers may be delayed by proactive measures to encourage a healthy lifestyle, but sooner or later we all fall sick and die. The need for expert and personal care, preferably within the community, will always remain. The diversion of resources to prevention must be in addition to, and not at the expense of, the traditional caring role of doctors and nurses in both primary and secondary care.
Dr Peter Baddeley
Painswick, Gloucestershire
