Giving patients more choice would encourage GP surgeries to innovate

SIR – In the Nineties, general practice was managed by Family Health Service Authorities. While GPs were still independent contractors, their availability and services were closely monitored. The Lansley reforms, first set out in 2010, swept away this supervision.

The other issue that needs to be examined is the lack of choice available to patients. In many towns, GP practices are amalgamating. This allows the practice to introduce complicated barriers to access with no option for patients to go elsewhere.

Perhaps the time is now right to move to a system where each member of the public receives an individual budget to “buy” their GP care. Having to earn funding by offering a good patient experience might well alter surgeries’ accessibility. Dr Robert Walker Workington, Cumbria SIR – Current pressures on A&E departments are not simply caused by the failure of GP surgeries to remain open all day, but by their failure to offer a sit-and-wait alternative to a formal appointment for all but a few hours a day.

I presented at my local surgery at half-noon with a suspected stroke and was given two options by the receptionist. Either someone else could drive me to A&E or I could attend the sit-and-wait surgery at two o’clock that afternoon.

How can A&E departments cope when, for 20 hours of a normal working day, they must deal with every unscheduled medical event? G J Wheeler Porthcawl, Mid Glamorgan SIR – Anyone who has ever spent time in hospital knows that, on being discharged, patients must often sit for hours at the bedside waiting for the pharmacy department to deliver the prescribed discharge medication.

If hospitals were to insist that discharged patients wait in the day room for their medication and subsequent transportation many hundreds of beds could be released hours earlier, making them available for those who truly need them. Ian Scott Sidmouth, Devon SIR – No social services department is going to be in a hurry to take an old person out of a hospital when they are ready to be discharged unless there is a financial value in doing so.

The hospital should charge £2,000 per night to the relevant social services should they fail to accept anyone ready for discharge, reflecting the hospital’s costs. Anthony Gilbert East Hendred, Oxfordshire SIR – A staff member looking for something in our now abandoned royal infirmary recently found the matron’s book for 1955.

The bed occupancy was then 96 per cent. Nothing changes. Robert Courteney-Harris Executive Medical Director University Hospitals of North Midlands