The term "de-skilling" is bandied around a lot nowadays, and in reference to GPs the implication is that GPs are able to do less and less than their historical counterparts. This is only true to a certain degree, because we are now required to know so much more than our medicl forebears. We have so much more that we can achieve.

    A generation ago, the GP would do everything; deliver babies (including Caesarian sections), take out diseased gallbladders, give anaesthetics, reduce major fractures and treat all emergencies. Now the GP surgeon is a rare person. The GP anaesthetist lives on, as does the GP obstetician, but almost exclusively in rural areas. Both of these have typically done extra training.

But the forces of de-skilling is insidious. Consider:

• with the drop in circumcision requests, few doctors are now comfortable performing this operation
• with the advent of family planning clinics, fewer doctors are inserting IUCD and contraceptive implants
• with vaccination clinics all over the place, will GPs stop giving vaccinations in the future?
• with podiatrists now doing foot examinations, will fewer doctors know how to do an ABI?
• with the availabilty of childcare nurses will GPs stop doing healthy baby checks?
• with the availability of ultrasound, will doctors become less competent in performing thorough abdominal examinations?
• with exercise stress tests becoming routine, will doctors become less competent at taking a good cardiac history?
• we have dieticians to design diets
• we have exercise physiologists to design exercise programs
• we have specialists in every field to do our work, for example how many GPs would look after a patient with breast cancer on their own?
• with ultrasound making it easier to inject joints, will GPs lose this skill?
• urban GPs rarely have admitting rights in hospitals

Areas in which we, the GPs are much more skilled include:

• applying evidence-based medicine
• using preventative measures
• a vastly increased knowledge of diseases
• a vastly increased knowledge of drugs
• the abiity to find information
• using computerisation