Hi Tom Brilliant post, if I may say. Now I do not do any on call, I was able to read it lying on the chaise longue, supping claret, wondering how to spend by £250,000 a year. I think I start by saying that one of the things I hate most about medical training (and I am as guilty as the next man) is the way the all people in health care, but doctors in particular, are trained to shit on colleagues. You soon learn the “hierarchy” at medical school. The physicians and the surgeons are at the top of the table, and shit on all below. And on each other. We move down the hierarchy to the rheumatologists, the dermatologists and so one and then, as we pass the salt we get to the serious pond life, like the GPs. Below them come the psychiatrists, the epidemiologists (what?) and so on. Further down the food chain we come to the nurses, the EMTs, the paramedics, the ambulance men, the St John’s people and the first-aiders. One of the signs of maturity of anyone working in healthcare is knowing their own boundaries. This is my big big problem with midwives. They do not understand their boundaries. And the nurse specialists in general are getting as bad. I am an experienced GP. I am pretty good at diagnosis, particularly diagnosis in the very early stages of illness. But let’s imagine there is a train crash. Or a bomb. Or a multiple RTA. I would be hopeless. For starters, I would panic. I know all the theory of ABC, of neck stabilisation, of the recovery position, and so on. Indeed, I give lectures on it, and when I am asked about the innervation of the diaphragm (very important for breathing) or the interpretation of ECG I am pretty hot. But don’t, please God, ask me to do it outside a hospital or health centre. I don’t “do” trauma. And I don’t want to do it. This is where you need paramedics. Or EMTs. Or whatever New bloody Labour is calling them today. Why could we not just stick with “paramedic”. We all know what that means. They are very good at this sort of thing. I am not. So I am deeply suspicious of BASICS. In theory a laudable organisation, and not totally without merit. But it is still a group of well-meaning GPs who have banded together to form an instant response traumatology service. Hmmm…….. Traumatology in the UK is not good, but this is not the way to do it. I would prefer the paramedics to stabilise the patient and get them to hospital. Now I am very good (I know that sounds cocky) at diagnosing hot poorly children. I can sit in my health centre or in a Casualty department or a walk in centre and I can do it. And I can do it efficiently and safely. It took about 10 years training before I got to the stage that I felt reasonable confident about it, and I still find it stressful at times. But then I learn that you don’t need to train for 10 years to assess sick children. You can do it three days. Really. In three days. http://www.practitionersassoc.co.uk/three_day If this is true, you do not need me. You do not need a doctor. You can put an ABC or a CED or a PMT or an ENT or whatever in Casualty to do it. It’s cheaper than me. This is the best example I can give you of the reasons why I get cross with dumbing down, and cross with the government undervaluing the skills of professionals trained to do jobs properly. It is lunacy. You cannot become a paediatrician in 3 years, never mind in 3 days. And the craziest thing of all is this. If the paramedics are all in hospitals doing my job, who is going to arrive on the M1 when there is a multiple pile-up? It will be…… ME! I have more free time under this system. More free time to spend some working for BASICs where I can explore my areas of ignorance. Madness. I wish the government would let us all get on with doing what we can do. John