Polly Toynbee describes how overstretched general practice is expected to manage hospital-revealed coronary calcification (Ben Shankland is a GP, but the rightwing press would tell you he’s an enemy of the people. Don’t listen, 16 January). But it is the NHS – over-managed and over-protocolised – that is itself sclerotic.
Since retirement as a NHS consultant, I have moved from working for the NHS to waiting for it. In the past month, following complications of a dubiously necessary investigation, my wife and I have spent an hour on the phone trying to contact her GP; waited 12 hours in A&E before seeing a relevant doctor; returned a few days later to be told her appointment was cancelled; then waited in all day for a similarly cancelled appointment. All could have been avoided had she had access to a GP who knew her and her history. Continuity? Care?
Money alone, though much needed, won’t solve the problem – the medico-industrial complex is waiting to gobble it up. A parallel major politico-medical culture change is needed. Wes Streeting, cut your waiting time; get thinking, now.
Name and address supplied
The catastrophic collapse of GP services has many causes apart from funding. This is at a time when, since I retired 10 years ago, I am now more likely to be a consumer. I come from a family who have given service in all branches of the NHS for generations, and none of them are happy.
When I meet other retired GPs, any discussion about the way general practice has gone ends up being a joint moaning session. Similarly, all I get are grumbles from my former patients when I meet them in the town. Sometimes the stories they tell are alarming. The concept of having a family doctor has gone. By the time I retired I had looked after at least two and sometimes three generations. One of my patients who I had known since birth is now my optician.
When I retired, Chard had 13 full‑time GP partners in three thriving practices, all of whom had a financial share in the running of the practice. It now has one practice and four GP partners (those who own the practice). Chard is a smallish market town in Somerset near the Jurassic Coast and would formerly have been considered a prime location to work in.
I cannot see the situation improving and in my opinion it has led to the excess death figures that are being bandied about. And if you think being a doctor entitles you to some respect as a patient, that went out of 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 factoid – a belief repeated so often that it has become true – circulated decades ago by the Department of Health in a document on long-term conditions. Even with a broad definition of “care”, GP consultations cannot equate to repeated encounters with medical specialists (often from several disciplines), nurses, advanced care practitioners, physiotherapists, occupational therapists, pharmacists and so on. It may be more accurate to say that footfall in NHS community-based services (to see GPs, nurses, pharmacists and optometrists) exceeds footfall in A&E departments and outpatients. The question then is: so what?
Steve Iliffe
Emeritus professor of primary care for older people, UCL
As someone with a son-in-law working his socks off as a GP in a relatively socially underprivileged London borough, I wholeheartedly agree with Polly Toynbee’s observations on the escalating GP workload, and her equally astute observations on the increasingly severe underfunding of this vital primary care sector of the NHS. How have we let this happen? And how can we bring to account those with government budget responsibility who have let this happen, and reverse funding to prop up GP practices and their overworked staff?
Rosie Oliver
Cloughton, North Yorkshire
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