I am an NHS psychiatrist, and I profoundly disagree with Simon Jenkins (Finally, some sense on the NHS: Wes Streeting recognises more money is not the only answer, 10 January). GPs are experts in the management of chronic conditions like diabetes, as well as common mental health difficulties like anxiety. They are also experts in diagnosis and triage. A woman is experiencing bloating. Is this ovarian cancer, or irritable bowel syndrome? Do they need a scan, a blood test, A&E, referral to a specialist, or none of the above? This is a GP’s job. They are not “gatekeepers” in the sense that Wes Streeting means.
I agree that the current system is flawed. The answer is not to dispense with referrals from GPs. Two things would happen: secondary care services – already under-resourced, with long waiting lists – would be flooded by those who could easily be managed in primary care, or who actually need a different specialty. That’s not a slur on the public; these decisions take expertise. In addition, urgent referrals would be missed. Cancer or heart disease often present with vague, insidious symptoms that many will not recognise as alarming.
What we need is more GPs, junior doctors, nurses, radiographers, psychologists, administrators and beds. Urgent appointments would then be more freely available, taking pressure off A&E, and allowing early referral to the correct service. We need more consultants in hard-to-recruit specialties such as psychiatry and A&E. We need joined-up social care and many more social workers to reduce the long waits for discharge from hospital. We need better morale, working conditions, facilities – and yes, better pay.
The proposal shows a fundamental lack of understanding. It would make a bad situation worse. People used to be seen by a cancer specialist within two weeks of a GP referral. We can achieve that again, but not this way.
Dr Melanie Knowles
Psychiatry specialist registrar, London
