The NHS is bound to need 300 managers to train 200 medical apprentices

sir – As part of the delayed workforce strategy, Amanda Pritchard, chief executive of NHS England, is to introduce apprenticeships (report, May 10) to fast-track school leavers into nursing and doctor positions, offering 200 places over the next two years.

This is a good – if small – step in the right direction. However, I predict that the NHS will be sure to set up another layer of executives, managers and administrative staff to run the scheme, probably employing significantly more than the 200 apprentices it is being designed to produce. A leopard does not change its spots.

John Snook

Sheffield, South Yorkshire

sir – Nursing apprenticeships are not “a radical new approach” but a return to the system under which my wife and thousands like her trained as State Registered Nurses until some halfwitted politician decided that nurses had to have a degree. The sooner we get back to practical training for a practical job, the better. For doctors, however, the situation is different. A doctor, as a diagnostician, needs a scientific, academic education so as to enable him or her to consider whether what appears to be condition A might in fact be condition B, C or D. Once, and only once, they have that background is it time for an apprenticeship form of learning. Those of my generation learnt in our clinical years by being part of a consultant-led “firm” which provided consistent teaching to its students and consistent treatment to its patients.

Dr David Pound

Charwelton, Northamptonshire

sir – The Government’s plan to upgrade phone systems and allow pharmacists to treat some medical conditions (report May 10) are welcome but will not greatly improve access to GPS. The difficulty that GPS face in providing sufficient appointments is as unwelcome to them as to patients and is due to the ageing population and the rise in patients per fully qualified GP.

In the early years of my 30-year GP career, there were fewer than 1,800 patients per fully qualified GP – now there are 2,300. Before, though very busy, we were able to allocate enough advance and on-the-day appointments to meet need. Now, it is impossible for GPS to fulfil demand. In many areas it is also impossible to attract GPS to replace retiring colleagues.

Reforming primary care, for example by making GPS salaried, may worsen this situation, as all GPS will then be entitled to finish their working day well before they now do, reducing the availability of appointments.

The NHS workforce plan needs to offer dramatic improvements in the number of staff in primary care, especially GPS, or NHS general practice will go the way of NHS dentistry.

Dr Phil Taylor

Kilmington, Devon

sir – The problem with “needless” GP appointments is that they are not known to be so until they are over.

Dr David Abell

Christchurch, New Zealand