Dr Phil Hammond, broadcaster and GP returner in Bristol

Weston-super-Mare – John Cleese was born there and Jeffrey Archer grew up there. However, to anyone medical in north Somerset, WSM is known for the macho traditionalism of its GPs. Here are men who still do 10 sessions a week and have 6-minute appointments. They put in the hours, earn the money and complain in a very macho way about what a bunch of wimps young GPs are these days.

OK, I'm generalising, but this was the impression I got from a lively educational meeting I attended. WSM is where the last few real GPs live.

Their extinction is likely to be accelerated by the difficulty the town has in recruiting new blood. Vacancies remain unfilled for months; new partners occasionally arrive but can't hack the pace, go off sick and then leave. Is it the work ethic or the swollen summer population of chubby Midlanders that drives GPs away? Or maybe we should blame it all on education.

As one senior partner put it: "Medical school is just a cake-walk now, junior doctors aren't allowed to do anything and GP registrars do an absolute minimum and prattle on about work–life balance. If you ask me, general practice is doomed."

This gloomy prophecy is nothing new. Ever since the arrival of the do-it-all nurse practitioner, GPs have been feeling uneasy about their future. Either you develop a special interest in dermatology or ENT and get the blame for closing your local hospital, or you sit and watch the nurses take over the NHS.

Fortunately, good practice nurses are hardly in abundance. It's not as if great herds of them are grazing the Mendips. The GPs of Weston are probably safe in their jobs for a while longer, but they still need help to replace their colleagues who take coronary-induced retirement.

And now help is at hand. An entrepreneurial Weston GP has flown to New York and recruited five physician assistants to add some glamour to the town.

Physician assistants, as anyone who has watched ER will know, are like practice nurses with knobs on. Given a bit of training and the right algorithms, they can do pretty much anything a GP does at a fraction of the cost. I'm told they retail at 40K a year, which is much cheaper than a locum (if you could find a decent one) or a salaried GP. And the placebo effect of the American accent will do more for the chubby Midlanders than a bucket of statins.

So well done Weston. You've found a way to chomp through the ever increasing workload while protecting most of the profits for the partners. But are there choppy waters ahead?

My worry is that the physician assistants will act as a reconnaissance mission for large American health corporations, who will take up New Labour's invitation to run entire health centres without a doctor in sight. If they can deliver services at 50% off, cash-strapped PCTs will bite their hands off.

A more likely outcome, I fear, is that the unique combination of Somerset and Brummie accents will prove to be too impenetrable for the American ear.

Add in the frustrations of British healthcare (most of what they order in the first five seconds of ER would take 6 weeks in the NHS) and my guess is that they'll be out of WSM quicker than you can say "Jeffrey Archer is innocent".

Guidelines in Practice, April 2006, Volume 9(4)
© 2006MGP Ltd
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