Mark Levy is to be congratulated for completing the review of asthma deaths.1 However in the way that they take a narrow specialist perspective, the recommendations seem to have been written by specialist physicians rather than primary care generalists. Specialist asthma clinics were largely abandoned both because the profusion of different conditions that general practice now manages makes such arrangements impractical, but also because restricting the times when patients could have their asthma reviews made it less, not more, likely that they would get any kind of review. As for the specialist training that he advises is the essential prerequisite for effective care, he must realise that, again, the large number of different conditions would place a burden on both nurses and doctors that will simply break the system. All that is required is familiarity with the latest research evidence and a willingness to try to apply them sensitively to the range of patients, with their range of asthma severity, taking into account those keen to manage themselves in a compliant way and those keen to deny the existence of their condition and anxious to reject all professional advice.
Every time that committed doctors investigate some particular area of practice they need to be reminded that the best primary care overall is provided by generalist doctors, and that any attempt to improve care for patients with particular conditions has to be integrated into general care and not bolted on as a vertical programme; and this is as true in the UK as it is in any developing country.
- © British Journal of General Practice 2014
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