The authors should be complemented on a fantastic analysis, challenging National Institute for Health and Care Excellence (NICE) guidelines appropriately. The problem with any assessment is that it is dynamic, patients can become ill, and it is a time-related assessment. My experience is that in children you need a face-to-face assessment with good safety-netting structures. The irreplaceable ‘gut’ feeling is only acquired by very many clinical encounters, so GPs recognise what they are looking for, because they then ask the right questions in the right way. Parental concerns can be misleading. I have seen several parents, who had good parenting skills, suddenly switching off their normal thinking process when a child was very seriously ill. This is an assessment that could be made pretty much on the spot.
Reduction of working hours, the European Working Time Directive, and lack of clinical exposure at all levels, including taking clinical responsibilities early in this training process, cannot be replaced by any guideline. The pendulum has to be swung backwards.
General practice is a beautiful job; however, it is never, ever going to be easy. It takes an extraordinary amount of effort to get it right. Training must be lengthened and intensified.
- © British Journal of General Practice 2022