GP service reform
SIR – In response to the letter from Nigel Edwards (October 9), the Chief Executive of Nuffield Trust, both Derek Morton and Maj Patrick Wallace (Letters, October 23) make the case for NHS GP services to be based on payments from the patient, backed up by an insurance system. An immediate start could be made, even without direct payments, by reforming how GPs are paid by the NHS.
Currently, the bulk of their income is derived from the length of their patient list, without necessarily seeing those patients. If the NHS paid for each patient seen, with perhaps double the fee if the doctor visited the patient, there would be a much greater incentive not to work part time or to institute systems that deter patients from obtaining appointments. Michael Staples
Seaford, East Sussex
SIR – Derek Morton makes a good point, but it is not the source of the funding (direct taxation vs compulsory insurance) that drives the effect, but the contract under which services are commissioned.
What he describes is a system where funding follows activity: this enables a service to expand to meet demand or for patients to take their funding elsewhere if demand cannot be met. This model is the only way general practice can survive. The current contract asks GPs to provide an unlimited service for a fixed fee, which may have been viable 20 or 30 years ago but is no longer fit for purpose.
We must also address and define what we actually want the NHS to offer. However the health service is funded, resources are finite and people must understand what they can reasonably expect. There will necessarily be boundaries to what is on offer, and these need to be set by the politicians or commissioners who are paying the bill, not the clinicians providing the service, who will always want the very best for their patients, no matter what the cost.
Dr Nick Aldred
Poole, Dorset
SIR – The recent inquiry into the East Kent Hospitals Trust (report, October 20) resulted in the Trust announcing that it has “lessons to learn”.
What is the point of any NHS inquiry if all we ever hear is that the NHS needs to learn lessons? When those lessons need to be learnt over and over again, and the lessons to be learnt have been known about for years but no effective action has been taken, nothing has been learnt.
This, along with the news that the NHS faces a £90 billion bill for “staggering” maternity blunders (report, October 19) – 70 per cent of total liability provision for NHS negligence – is utterly shocking. The liabilities and lessons we have learnt establish only that the NHS does not need more funding, but to do its job properly and learn from past mistakes.
Victoria Hawkins Ludlow, Shropshire