Charge to see the GP

SIR – As a retired GP, it seems to me that we are skirting the vital question: how do you make free healthcare work?

The answer is that you need patients who understand the principles behind a free service, and use it appropriately, and clinicians who can process high numbers of patients quickly and efficiently. Neither of these conditions exists today.

The former has been destroyed by encouraging patients to see the NHS as a consumer organisation, while bureaucracy, litigation, computerisation and medical complexity have seen the demise of the five-minute consultation, which was the only factor preventing the NHS from being overwhelmed.

Part of the problem is that a sizeable minority of patients use the NHS out of all proportion to their need – a situation that cannot be allowed to continue with the service on its knees.

The only solution I can offer, short of complete privatisation, is to start charging for GP appointments, which may weed out some of the unnecessary visits and give the NHS a chance to steady the ship.

Dr Chris Nancollas Yorkley, Gloucestershire

SIR – Can we rid ourselves of the notion that GPS only work when they are seeing patients (Letters, May 13)?

As a typical GP I “only” see patients three days per week. The majority of the rest of my 50 to 60-hour week is spent doing patient-related tasks such as completing prescriptions, filing results (including dealing with abnormal results), responding to patient queries and hospital clinic letters, writing reports, and dealing with safeguarding issues.

This is in addition to all the other tasks, such as supervising GP trainees and other clinical staff, supporting non-clinical staff, giving clinical input to managerial issues, overseeing information governance and safeguarding, attending practice meetings, and keeping up to date with recent changes in clinical guidance and protocols.

The lights in your local GP surgery will stay on long after the last patient goes home.

Dr Gillian Mcilroy Shoreham-by-sea, West Sussex