In this country the NHS provides medical care within a two-tier system. At one level, the patient has direct access to a doctor, most commonly the general practitioner, but alternatively the firm doctor, the school doctor, the doctor staffing an accident and emergency department, a VD or family planning clinic. At the other level, access is only by referral, as to a hospital specialist. Good medical care is helped by continuity across these levels and this is probably best maintained when the GP, specialist, and patient comply with the dual system. The GP is the first person to whom most medical problems should be brought, who decides whether or not a specialist’s advice is needed, who is responsible for looking after the patient when he or she is not in hospital and who maintains the patient’s records. Thus the GP provides personal, primary and continuing medical care to patients and families. The specialist gives advice on diagnosis and treatment on consultation and is totally responsible for the patient if he or she is in hospital.
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