Dr. John Devlin:

If a doctor or a consultant is unable to provide a treatment for whatever reason, the Medical Council is very clear that the doctor must co-operate with whoever provides it, to include transfer of notes. That depends on the interaction between the patient and the doctor. The doctor is then obliged to go along with that. The possibility is there for a second opinion.

The other issue that has been raised is the role of doctors and consultants, as two separate entities. Of course it is not like that in practice. Whether it is this or any other aspect of clinical care, most care is provided on a shared care basis, so the doctor is working together with the GPs. Shared care means that the roles and responsibilities for consultants and GPs are clearly identified so the GP knows what he or she is doing and the consultant knows what he or she is doing. The difference between consultants who work in acute hospitals and general practice is just in respect of their training programmes. Consultants have great expertise and training in specific disease clinical areas and have developed a competence and expertise which may give them greater knowledge in relation to particular issues, whether it be neurosurgery, and so on. General practitioners on the other hand are generalists. When it comes to dealing with complex drug interactions, it is quite relevant and clinically appropriate that one would have the advice of the consultant available who would have an understanding of the condition, which may be a rare condition, which the GP may or may not have and be able to manage that. In other words that is a clinically appropriate way of dealing with a very complex case. Certain patients may often be on multiple medications. The consultant, by virtue of the training and expertise has a good understanding of those interactions, hence it is reasonably appropriate that there is consultant supervision in terms of what is now essentially a new treatment being proffered.

There needs to be an education on this and that is part of the work of this group. When the procedures, operating clinical protocols and everything else are put in place these are communicated to the relevant specialties including general practice and will be part of the training on an ongoing basis.