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Editor-I was surprised that tensions between primary care and specialist
doctors was highlighted as a summary point in Roberts' excellent article on
the imperfect market in primary care (1). The fee-for-service model that
has, until recently, dominated the U.S health care system (or "non-system"
as it has been described (2)), might have promoted competition between
generalists and specialists on the other side of the Atlantic. In the U.K
however, there is little in the way of empirical evidence to suggest that we
have similar problems. The general practitioner's gate-keeper role which was
promoted by the 1911 Health Insurance Act and formalised by the formation of
the NHS, has all but eliminated competition. The only significant public
disputes between the two branches of the British medical profession have
been over access to hospital beds (more than a century ago) and the
structure of a national health service (fifty years ago); not bad for a
profession which celebrates its 140th birthday this year!
Between 1994 and 1997 I conducted a study of the professional relationship
between GPs and specialists in South West England. This demonstrated a
significant desire on the part of both branches of the medical profession to
learn (3) and work (4) together. After an initial period of well-publicised
posturing, even the internal market was felt to have contributed to improved
understanding of each others' roles, responsibilities and work pressures.
I think we can be reassured that despite the functional, philosophical,
educational and organisational differences between the two branches of the
profession, British doctors recognise the benefits of collaboration.
Martin Marshall
Harkness Fellow of the Commonwealth Fund of New York
Mount Pleasant Health Centre
Mount Pleasant Road
Exeter EX4 7BW
1. Roberts J. Primary care in an imperfect market. BMJ; 1998;317:186-9
2. Brook RH. Practice guidelines: to be or not to be. Lancet; 1996;348:1005-6
3. Marshall MN. A study of educational interaction between general
practitioners and specialists. BMJ; 1998;316:442-445
4. Marshall MN. How well do general practitioners and hospital consultants
work together? A qualitative study of co-operation and conflict within the
medical profession. Brit. J. Gen. Prac.; 1998;48:1379-1321
Tension between generalists and specialists
Editor-I was surprised that tensions between primary care and specialist
doctors was highlighted as a summary point in Roberts' excellent article on
the imperfect market in primary care (1). The fee-for-service model that
has, until recently, dominated the U.S health care system (or "non-system"
as it has been described (2)), might have promoted competition between
generalists and specialists on the other side of the Atlantic. In the U.K
however, there is little in the way of empirical evidence to suggest that we
have similar problems. The general practitioner's gate-keeper role which was
promoted by the 1911 Health Insurance Act and formalised by the formation of
the NHS, has all but eliminated competition. The only significant public
disputes between the two branches of the British medical profession have
been over access to hospital beds (more than a century ago) and the
structure of a national health service (fifty years ago); not bad for a
profession which celebrates its 140th birthday this year!
Between 1994 and 1997 I conducted a study of the professional relationship
between GPs and specialists in South West England. This demonstrated a
significant desire on the part of both branches of the medical profession to
learn (3) and work (4) together. After an initial period of well-publicised
posturing, even the internal market was felt to have contributed to improved
understanding of each others' roles, responsibilities and work pressures.
I think we can be reassured that despite the functional, philosophical,
educational and organisational differences between the two branches of the
profession, British doctors recognise the benefits of collaboration.
Martin Marshall
Harkness Fellow of the Commonwealth Fund of New York
Mount Pleasant Health Centre
Mount Pleasant Road
Exeter EX4 7BW
1. Roberts J. Primary care in an imperfect market. BMJ; 1998;317:186-9
2. Brook RH. Practice guidelines: to be or not to be. Lancet; 1996;348:1005-6
3. Marshall MN. A study of educational interaction between general
practitioners and specialists. BMJ; 1998;316:442-445
4. Marshall MN. How well do general practitioners and hospital consultants
work together? A qualitative study of co-operation and conflict within the
medical profession. Brit. J. Gen. Prac.; 1998;48:1379-1321
Competing interests: No competing interests