No threat to NHS from an American trade deal

sir – There appears to be some confusion over the mooted “privatisation” of the NHS that could occur as a result of a trade deal with America (Letters, November 6).

The NHS buys pharmaceuticals and services from companies across the globe. It buys on the basis of quality and price. We have had in place for decades a system, the Pharmaceutical Price Regulation Scheme, which controls the price of drugs sold to the NHS, whether they are produced in this country, in the EU or beyond.

Any trade agreement with America will not override this arrangement. America already has full access to the UK market and has to compete with other suppliers. There is no pricing free-for-all. The NHS will remain free to purchase – or not – the drugs that it needs, as is the case at present. Tim Lovett

Claygate, Surrey

sir – Rosie Taylor (Health, November 4) asks if our GPS are fit for purpose.

The shortage of staff is one of two fundamental weaknesses in

NHS primary care. This country has significantly fewer GPS per 100,000 population than almost all other European countries, so the long wait for a short appointment is entirely predictable. What is surprising is the absence of any apparent long-term plan by the NHS to rectify the number of available GPS by increasing training places and addressing remuneration and pension issues.

The second major weakness in the primary care system is that the remuneration of GPS is based in large part on the headcount of patients registered with a practice, rather than payment for services provided. The headcount system prevents patients from seeking a consultation at another practice, and it also makes it difficult for GPS to provide medical services beyond a 10-minute consultation. When I lived in Germany I had a regular GP, but the state insurance system provided me with a plastic card that allowed me to consult any other GP if necessary. Richard Jenkins

Beaconsfield, Buckinghamshire