Behind the staffing crisis in general practice

SIR – Most general practices are owned and run by independent contractors rather than by a salaried workforce, and most GPs put loyalty to their patients ahead of any loyalty to the Department of Health.

Over many years and under governments of all persuasions, the Department of Health’s approach has been to reduce GPs’ autonomy and increase bureaucracy, making their workload unsustainable. This has led to a long-standing manpower crisis, which in turn has led to lengthy waiting times for routine appointments and the current threat to home visits (Comment, November 24).

Such a situation is clearly bad for GPs and patients, and it is also bad economics. Done well, general practice is far more cost-effective than hospital care. Dr Tim Cantor

West Malling, Kent

SIR – Having had an infected arm dressed and antibiotics prescribed at my local surgery, I was most pleasantly surprised when the nurse rang me up a day later to see if I was feeling better and offered to visit me on her day off to check if the dressing needed changing.

Some practices still operate beyond the call of duty. Patrick Briggs

Cambridge

SIR – It is a sad fact that “fast dentistry” (“‘Slow dentists’ say it’s better to be patient in the chair”, report, November 24) is the reality for NHS patients across England and Wales. The system, and our contracts, put chasing government targets ahead of patient care.

Every year, it’s not about the oral health improvements we secure, but about the boxes ticked. Hit targets early, and we can’t see any more NHS patients. Fail to make the grade, and we face financial penalties. It’s a system that means a dentist gets paid the same for one filling as for five, and one that can leave practitioners out of pocket when treating patients with high needs. As health professionals, we need the next government to give us time to care. Mick Armstrong Chairman, British Dental Association London W1