Acute medicine – an alternative take (2)

Editor – The article on ‘acute medicine – an alternative take’ (Clin Med Feb 2011 pp 26–7) suggests we should employ GPs for £450 a day (or more) as GPs with special interests (GPwSIs) in acute medicine. This comes a month after an article suggesting that by 2014 we will have a massive surplus of certificate of completion of training holders across all the main medical specialties. The compelling reason to employ a GP in a hospital setting on a higher salary than a newly employed consultant is apparently experience. I would suggest we are profoundly underselling the experience of five long hard years as a medical registrar working out of hours if we feel experience as a GP is more valuable than this training. I am not saying we should be protectionist but we need to be clear about the value of a trained consultant. Unless GPwSIs provide clear and compelling evidence, rather than anecdote, to support them working in an environment outside their original training, we should invest in expanding the consultant workforce and employing consultants in acute and general medicine. Furthermore, the lack of a formalised training programme or qualification for GPwSIs means that we should be extremely cautious about extrapolating results from small enthusiastic units. If the GP (himself FRCP, FRCGP) demonstrates successful outcomes, does this really mean this can be reproduced by every GP with an interest in acute medicine?