ABSTRACT
Specialists are generally paid by fees for each consultation, encouraging referral and retention of patients in hospital clinics for follow-up. Primary generalists should, as a general rule, be better placed than specialists, and more appropriately trained, to manage uncomplicated high blood pressure in middle and old age. The commonest problem in diagnosis is an insufficient number of readings, and the commonest problems in treatment are poor compliance and/or alcohol. Such difficulties should be more easily detected and overcome in primary than in secondary care. Less than half of GP-referred patients met one or more of these criteria, so evidently fairly large numbers of GPs pass responsibility to specialists even for routine care of uncomplicated high blood pressure in middle age. Patients are bigger and doctors are smaller in primary care than in hospitals, and that situation should create a better learning environment.
