A new agenda for primary care

A new agenda for primary care

GPs' workloads hit the headlines this week when over a hundred surgeries closed on Tuesday 1 May, 2001 as part of a national day of protest. The government has promised to increase the number of doctors working in primary care, but Cambridge academic Dr Jon Emery predicts that developments in medical genetics will only add to their burden - giving GPs new responsibilities and forcing them to acquire new skills.

Dr Emery is a clinical lecturer in the Department of Public Health and Primary Care. In an article in last week's British Medical Journal he assessed the practical implications of the new genetic medicine, describing how the latest discoveries at the cutting edge of biomedicine are likely to affect those in frontline medical services.

"Since the identification of several genes that underlie certain familial cancers, referrals to clinical geneticists have risen considerably - at Addenbrooke's referrals to the cancer genetics clinic almost doubled in the year to mid-1999," explains Dr Emery. As scientists identify more genetic mutations that increase risk of common diseases, clinical genetics departments will be unable to cope with a further rise in demand. All branches of medicine, especially primary care, will be required to advise patients about genetic issues.

Dr Emery believes that UK primary care is well placed to support an integrated genetic service because of its traditional focus on the family and relatively well computerised longitudinal health records: "Already GPs are involved in discussing predisposition to certain cancers and screening for common recessive disorders such as cystic fibrosis," he says.

But if they are to fulfil their new roles then GPs will need to learn new skills in family history taking and counselling. "Genetic risk assessment requires detailed family histories - GPs will need to learn how to recognise common patterns of inheritance and they will also need an awareness of how ethnicity can determine risk," explains Dr Emery. "Genetic screening also raises the question of how to tell people that they may be predisposed to a serious or even fatal condition. Doctors will need more training in how to communicate risk and how to counsel in a non-directive manner."

In the future we can also expect to see the use of genetic information in managing the treatment of patients' conditions with drug selection and dosage tailored to individuals. Pharmacogenetics could be used to identify patients who are at risk of severe adverse effects from drug treatment or whose genetic make-up means they are unlikely to benefit from a particular treatment.

Many of the benefits which genetic medicine promise will take some time to materialise but Dr Emery believes there is no room for complacency: "If even a fraction of the claims made about the impending impact of genetics on clinical practice came true, clinical genetics services would be overwhelmed. We must not miss this opportunity to prepare primary care for the new genetics."

Further information
See the full article at the BMJ website: www.bmj.com

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