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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2009 September 1; 59(566): 694.
PMCID: PMC2734363

Vertical versus horizontal integration

I was impressed by Martin Marshall's clearly thought out analysis of the role of general practice in a modern health system,1 although one might debate the detail. For instance, personally I regret the loss of 24-hour responsibility and only reluctantly accept the strength of his argument in relation to this. However, Marshall's three core principles might be a useful basis for looking at many current problems — and one in particular — swine flu.

The three principles, paraphrased and abbreviated, are that GPs are: medical generalists who are up to date with the evidence; committed to whole person care; and advocates on behalf of their patients.

For swine flu, a vertical approach is encouraged in which services are provided in a uniquely different way for one condition of supposedly over-riding importance. This is unlikely to work well in primary care. Many patients who think they have swine flu have nothing of the sort and are disproportionately or inappropriately worried. A few who are discouraged from consulting face-to-face will turn out to have meningococcal meningitis and suffer a worse outcome because of the delay in diagnosis. Guidelines and policy have very little evidence underpinning them, and where there is evidence or lack of it this information is not being made available to GPs or to the public. Care of individual patients is taking second place to flattening the pandemic curve and we are doing our patients a disservice if we accept this ordering of priorities without question.

It is, perhaps, not surprising that politicians, the media, and the public have a poor grasp on science and it may not be news to us that many scientists and medics don't appreciate the nature of general practice. However, I find it disappointing that our GP leaders seem, largely without protest, to accept the official policy that reflects a poor understanding of both.


1. Marshall M. Practice, politics, and possibilities. Br J Gen Pract. 2009;59(565):605–612. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners