Abstract
Summary Within the National Health Service (NHS), generalphysicians are the specialists in Internal Medicine and are based exclusively in the hospital service, while general practitioners provide primary care. Except in emergency, patients can only be seen by specialists in Internal Medicine at the request of their general practitioner. The general physician provides acute emergency service in hospitals but also has specialty interests, the most common being cardiology, endocrinology, gastroenterology and thoracic medicine. Geriatrics is a speciality in its own right but there is some integration with Internal Medicine. Increasing specialisation has posed a threat to Internal Medicine with the risk of fragmentation of care. There are stringent manpower controls, which result in far fewer specialists in Internal Medicine in the NHS than in most other parts of Europe.
Published Version
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