Sir, Professor Sir Denis Pereira Gray (letter, July 30) underestimates the significance of high turnover of local population as a factor influencing continuity of care by GPs. In cities, where most of the population live, the turnover may be 25 per cent per annum or even higher, especially in those families who are least stable and who therefore need the most help.
Far from defending the principle of continuity of care by one GP, Sir Denis should recognise that patients might get better care when they carry their own medical records (preferably on disk) instead of waiting interminably for them to be transferred from one registered doctor to the next. Furthermore, GPs should compete with each other in providing responsible care, rather than focusing on continuity of care which does not necessarily have universal benefits.
Sincerely,
ROBERT LEFEVER,
2a Pelham Street, SW7 3HU.
July 30.
From Mr Barry Morse
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Sir, Sir Denis makes an entirely sensible point about the importance of patients seeing their own GPs and, if necessary, waiting to see a particular GP.
Unfortunately for the patients of far too many practices, seeing any GP within a reasonable time is difficult, because of the practice of booking appointments too far in advance. A consequence of this is that patients who, for example, need a “sick note” end up seeing a GP only when recovered, unless able to predict their illnesses weeks in advance.
At my local practice appointments (unless pre-booked as follow-ups by doctors) can only be made from 4pm the day before, or on the day itself. Late-afternoon slots are made available for emergencies. This means that patients can see a GP when they are actually unwell.
Yours faithfully,
BARRY MORSE,
Upper Mill,
Usk, Monmouthshire NP15 1BL.
barry@morse777.fsnet.co.uk
July 30.
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From Dr Tim Palmer
Sir, The difficulties facing patients hoping to get an appointment with their GP are mirrored by the anxieties of GPs trying to provide an accessible service. There is an enormous and increasing pressure on appointments that is difficult to solve without robbing Peter to pay Paul. Rapid access allows people with minor illnesses to choke the system, while forward booking doesn’t adequately address those who have acute illnesses, which need urgent care.
Triage, or pre-assessment, of patients who consider themselves acutely ill can help to reduce the appointment lottery, and in many cases replaces the wise words of a senior member of the extended family, which no longer seems to exist.
My practice, in a pleasant area of Kent, cannot recruit locum doctors for maternity leave or holiday cover, and young doctors do not want the professional burden of general practice.
The nub of the appointment crisis is: too few doctors providing too few appointments for patients who have an unrealistic expectation of a healthcare system that was designed for the ill rather than the worried well.
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Yours faithfully,
TIM PALMER
(General practitioner),
64 Pembury Road,
Tonbridge, Kent TN11 9HY.
doct@btinternet.com
August 1.