Headlines: September 22nd, 2006



Doctors must debate the issue of hospital closures and GPs should reassert themselves as advocates for patients, according to an article in today’s BMJ by Oxfordshire GP Richard Lehman. He says the issue has suddenly become headline news but it has never been the subject of a full national debate in the profession.

Dr. Lehman, a GP in Banbury, where he has been involved in efforts to maintain a full range of services at the local hospital, writes that for 15 years there has been talk about centralising services and local campaigns over threatened hospitals, but little systematic collection of evidence to inform decision making. Instead, his article argues, the process has been driven by financial pressures, the European Working Time Directive and its effects on junior doctors’ staffing, and recommendations from the royal colleges.

These pressures, he says, have led to hospitals amalgamating services, at a cost to local accessibility. The moves are deeply unpopular with patients who might have to travel considerable distances for acute care that was once available closer to home. Services most likely to be cut or merged are paediatrics, obstetrics, and emergency care, the ones that patients particularly want to be near.

Dr. Lehman says trusts seeking to maintain a lower level of service face a dilemma. He cites the example of replacing a consultant led obstetric service with a midwife led birth unit. Such units only accept “low risk” births, but emergencies inevitably occur, requiring transit to the nearest consultant led facility and if cost is allowed to be the dominant factor that may be a very long distance away.

This issue, he argues, is one of several that should be debated urgently before a further wave of changes sweeps the country. The debate cannot be timed or located to suit electoral convenience. There should be clearer guidance on issues such as safe transit times for paediatric and obstetric emergencies, and more creative thinking on shared site working and flexible training rotas.

Dr. Lehman concludes, “It is time for GPs to reassert their role as patients’ advocates, defending the principle of local care for local people. If doctors do not take an active role in questioning the present direction of policy then the public will rightly see us as more interested in our own career structures and hours of working than in providing a safe and accessible service.”