Polly Toynbee describes how the overstretched GP practice is expected to manage the coronary calcification revealed in hospital (Ben Shankland is a GP, but the right-wing press would tell you he is an enemy of the people. Don’t listen, January 16). But it is the NHS – over-managed and over-protocolled – that is itself sclerotic.
Since retiring as an NHS consultant I have moved from working for the NHS to waiting for it. This past month, due to complications from a questionably necessary examination, my wife and I spent an hour on the phone trying to contact her primary care physician; waited 12 hours in the emergency room before seeing a relevant doctor; returned a few days later to learn her appointment had been canceled; Then waited all day for an appointment that was also canceled. Everything could have been prevented if she had had access to a GP who knew her and her history. Continuity? Concern?
Money alone, even if desperately needed, will not solve the problem – the medical-industrial complex is waiting to gobble it up. A parallel major political-medical cultural change is needed. Wes Streeting, shorten your wait time; now start thinking.
Name and address provided
The catastrophic collapse of primary care has many causes besides funding. This is at a time when, since I retired ten years ago, I am now more likely to be a consumer. I come from a family that has provided services in all branches of the NHS for generations, and none of them are happy.
When I meet other retired general practitioners, every discussion about the state of affairs in general practice ends in a collective lament. Likewise, I get nothing but grumbling from my former patients when I see them around town. Sometimes the stories they tell are alarming. The concept of a general practitioner has disappeared. By the time I retired, I had cared for at least two and sometimes three generations. One of my patients who I have known since birth is now my optician.
When I retired, Chard had thirteen full-time GP partners in three thriving practices, all of whom had a financial stake in the running of the practice. There is now one practice and four GP partners (the owners of the practice). Chard is a small market town in Somerset, close to the Jurassic Coast, and was once considered a prime location to work in.
I don’t see the situation improving and in my opinion this has led to the excessive death rates that are being discussed. And if you think that as a doctor you are entitled to any respect as a patient, that went out the window years ago.
Dr. A. Peter Glanvill
Chard, Somerset
Polly Toynbee says that “up to 90% of care” is provided by GPs. This is a fact – a belief repeated so often that it has become true – disseminated decades ago by the Ministry of Health in a document on long-term conditions. Even with a broad definition of ‘care’, GP consultations cannot be equated with repeated encounters with medical specialists (often from multiple disciplines), nurses, advanced healthcare practitioners, physiotherapists, occupational therapists, pharmacists and so on. It may be more accurate to say that footfall in NHS community services (to visit GPs, nurses, pharmacists and optometrists) exceeds footfall in A&E and outpatient settings. The question then is: what then?
Steve Iliffe
Emeritus professor of primary care for the elderly, UCL
As someone with a son-in-law doing his best as a GP in a relatively socially deprived area of London, I wholeheartedly agree with Polly Toynbee’s observations on the escalating workload for GPs, and her equally astute observations on the increasingly serious underfunding of this essential healthcare. primary care sector of the NHS. How did we let this happen? And how can we hold to account those with government budget responsibility who allowed this to happen, and roll back funding to keep GP practices and their overworked staff afloat?
Rosie Oliver
Cloughton, North Yorkshire