Our Byzantine healthcare system prevents GPS from doing their job
sir – The NHS wants to do everything on the cheap, with the result that we have an overstretched, inaccessible system that is deteriorating year on year (Leading Article, December 23).
One of the problems in primary care is the number of non-clinical layers that patients have to navigate in order to see someone capable of assessing their problem. The patient is often frustrated by the time they reach a GP, having been inadequately assessed by NHS 111, nurse-led urgent care centres, triage, pharmacists and paramedics.
When the patient does get to see a GP, the service they receive is second best. There is too little consultation time, and insufficient resources for near-patient testing. Long waits for referral – or even referral blockage – mean that patients, desperate for help, besiege our A&E departments.
Millions of pounds are spent supporting such organisations as the National Institute for Health and Care Excellence, NHS England and others, which divert resources from patients. Our politicians’ penchant for untested technological solutions will further exacerbate matters (although these technologies will clearly have a place as part of a blended care system).
I was a GP for more than 30 years and witnessed the degradation of our services caused by decisions made and enforced centrally. I am not surprised that few wish to become GPS – and that many are retiring early. Dermot Ryan FRCGP
Kegworth, Leicestershire
sir – We must not give up on the current model of general practice. It is not “broken”, as J Meirion Thomas suggests (Comment, December 19) in his latest attack on the NHS service that patients trust most.
British general practice is tried, tested and the envy of other countries. It is valued by patients, alleviates pressure on hospitals and keeps the NHS sustainable. If it is to carry on working effectively, it needs more resources and more people, to give us more time with patients. We are already expanding our practice teams and exploring new ways to deliver continuity. But we will always require the expert skills of GPS. We need more of them, and my college will not apologise for banging that drum. Professor Martin Marshall
Chair, Royal College of General Practitioners
London NW1
sir – The foundation of good clinical care is a thorough assessment of a patient by a GP. GPS are trained to focus on the whole patient, to listen and to think carefully before ordering tests or prescribing medicines.
I once saw a patient who was being monitored by the local pharmacist and specialist nurse for his heart failure. His weight was fluctuating widely and, despite a raft of investigations, things were not improving.
When I spoke to him, he said he felt quite well – but told me that on some occasions he was being weighed when he was not wearing his artificial leg. Dr Nick Summerton
Brough, East Yorkshire