Labour leader Keir Starmer unveiled his party’s latest proposals for general practice yesterday – amid bewilderment and criticism from doctors.

Starmer repeated his party’s proposals to allow patients self-referral to specialists and to abolish GP partnerships. He cited as examples persistent back pain and “internal bleeding”. He said this would release GPs to focus on patients, setting out proposals to double the number of graduating doctors and calling for reductions in management costs.

Writing for the Sunday Telegraph, Starmer stated: “Why can’t people with persistent back problems self-refer to physio. Why if you notice bleeding do you have to get a GP appointment, simply to get the tests that you then do yourself at home? Every patient will have their own experience of these mundane inconveniences and inefficiencies. Across the system and across the country each one adds up, resulting in a mind-boggling waste of time, energy and money, all of which could be better spent.”

The senior geriatrician Dr David Oliver said: “How many of those self-referrals will be for things that primary care could comfortably deal with (if it was properly resourced and staffed)? Or a GP would have helped steer to a more appropriate specialty?”

Guildford GP Dr Martin Brunet added: “Self-referral to specialists is a terrible idea. This is because primary care and secondary have a totally different approach since we see a different cohort of patients. Apply secondary care principles to the patients a GP sees and costs would sky rocket.”

Nuffield Trust chief executive Nigel Edwards tweeted: “Internal bleeding as an example? Gosh. A reminder – If just 5% of primary care skin consultations went straight to dermatology, we would need two times the number of consultants or some very nifty AI. Old style gatekeeping is not the answer intelligent referral/advice & guidance is.”

GP Dr Helen Salisbury, a BMJ columnist, stated: “Keir, please, talk to a doctor before you embarrass yourself and your party further by making up health policy on the hoof and talking rubbish. If you do have internal bleeding go straight to A&E, go directly to A&E, do not stop by your GP.”

Media GP Dr Ellie Cannon wrote: “I am so insulted and shocked by Keir Starmer interview on NHS. People bleeding can self refer and do tests at home? Have you ever been to a GP!? We examine, diagnose, triage, investigate and treat, ourselves? What if the bleeding is nothing? Use specialist time anyway?”

Dr Rachel Clarke, the Oxford based palliative specialist, responded: “Persistent back pain could be caused by metastatic cancer, multiple myeloma, bacterial discitis, osteoporosis, tuberculosis, spinal cord compression, multiple sclerosis. But yes, Keir Starmer, let’s fix the NHS by binning GPs and their terrible skills at triage. Who needs them?”

Starmer won some support from former Royal College of GPs chair Dame Clare Gerada, who responded: “But someone with six weeks persistent pain will no doubt need a referral for tests. In my experience, now, more than 35 years, we have to empower patients and allow them better access to investigations and expand the gate more.”

Dr Gerada added: “If a patient has breast/scrotal lump of course they can see us first. But why not allow the patient to fill the week referral form? Patient knows their own details (site, size, duration, family & personal history etc). Why wait for GP appointment? Lumps almost always need more investigations. Same goes for bleeding. Of course, patient can see us first. But it’s not difficult (and we can do today) to determine without seeing patient (unless they want to) who needs to have further investigations. Why not allow direct access to the tests/service. Why the need to see GP first & create delays?”

The Sunday Telegraph, also reported analysis by the Department of Health suggesting that abolishing GP partnerships would cost £7 billion. The costs include £7 billion to buy premises and £670,000 a year to put GPs on NHS pay scales.

It quoted Starmer as adding: “It’s time for us to think about a new, sustainable system, one that allows GPs to focus on caring for patients rather than the admin that comes with effectively running a small business. This would be a big change and it won’t happen overnight. But I am a pragmatist, focused on what works for patients. As GPs retire and those contracts are handed back, I want to phase in a new system that sees GPs fairly rewarded within the NHS, working much more closely with other parts of the system.”

The Doctors’ Association UK and GP Survival wrote a joint letter to Labour shadow health secretary Wes Streeting on Friday raising concerns about his GP policies, stating it was based on “flawed information and misconceptions”.

GP Survival chair Dr John Hughes said: “GP Survival members have been extremely concerned at Wes Streeting’s comments and declared plans for reform of UK general practice, which seem to be based on misinformation and lack of understanding of the real issues and pressures faced daily by understaffed and underfunded practices.”