LETTERS
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From: Jayantha Gunawardene, Great Ormond Street Hospital Trust
Subject: NHS reforms
In the US the government is en- couraging hospitals to take con- trol of local GP services as expen- diture of insurance payments can be better controlled at hospital level. In the UK it is the opposite, with more control by the local GP.
Whatever the preferred model is, in my opinion a patient should be able to walk into a high street medical centre, pay a very nomi- nal fee and see a doctor at very short notice. It is as simple as that. We should not be waiting days to see a GP, months to see a con- sultant (if paying, next day) or be encouraged to walk into A&E for immediate
attention. Have you
stopped for a moment and asked the patient what quality of service he/she wants?
A patient needs care as soon as possible, not debates and discus- sions about the best healthcare model.
From: John Holden,
Practitioner, St Helens Subject: NHS reforms
I could not agree more with the ‘42 high-profile GPs who have writ- ten to the Daily Telegraph’ - the current reforms are the right way forward for the NHS. Rather than dismantling the service they will ensure its survival for many more years.
I believe the BMA and RCGP are out of touch with day-to-day reality for GPs, hospital doctors and others. The huge daily frustrations
involved in running
the service have to be seen to be believed, and it is frail, vulnerable elderly patients who suffer most as a result.
PCTs have been very inefficient, remote from patients and basical- ly risk-averse. I am delighted they
General Lansley: under fire
are being abolished. In particular it has been exceptionally frustrat- ing to have an administrator-led NHS, especially when it is almost unknown for them to have ever worked in general practice.
I am convinced that GPs can work with hospital doctors and others to bring about the most important change the NHS requires – the end of recurrent hospitalisation for the frail elderly who suffer a great deal from unnecessary, distress- ing secondary care. The creativ- ity and caritas of GPs and others should be able to bring about that vital transformation facilitated by the Government’s reforms.
From: Dr Eric Watts, Consultant Haematologist, Basildon & Thurrock University Hospitals NHS Foundation Trust Subject: NHS reforms
I am very concerned that GPs lack the necessary specialist knowl- edge to carry out effective com-
missioning - all my GP friends agree. The GPs that have been quoted as being in favour are not a representative group.
I am particularly concerned that they see insufficient numbers of serious illnesses that can be dif- ficult to diagnose. Lack of aware- ness through lack of clinical in- volvement with these cases could lead to them having difficulty commissioning these services - they have no expertise in these areas.
What we need to ensure for high quality services is a mature dia- logue between GPs and special- ists - giving money to generalists to buy specialist services can only be justified if the generalists agree to learn all they need to know about the services in order to spend wisely. Frankly I think this is unlikely.
Teenagers and young adults with cancer have on average to see
their GPs four times before the GP refers them to a specialist - this reduces their likelihood of cure - if we take the approach that GPs should do more and hospitals less, then there will be more delays.
The statistics show that once a GP refers a patient, then we see them very quickly. The problem is making the GP aware in the first place - they really do have a lot to do already and we should be improving their awareness of delayed diagnosis rather than giving them headaches over commissioning.
I have heard that the local PCT are planning to close our community hospital, which will mean more work for acute unit whilst we are being told to make savings - this will increase our difficulties.
Over the years we have seen im- provements and I do see GP com- missioning as a genuine problem as they don’t see enough of these uncommon cases to know the early warning signs.
From: Tony Rollo, patient repre- sentative, Anglia Cancer Network Subject: Doctor / patient knowledge
I have no idea why Nick Clegg thinks that the GPs are the ones who know their patients best. We still have a large number of cancer patients presenting at A&E rather than referred by their GP.
GPs only see a small proportion of the patients on their lists in any one year and very few of these will have cancer, as a result many GPs do not adequately recognise the symptoms. The two-week wait is working but that’s because GPs are now using guidelines from the Cancer Networks.
These networks have driven many changes, which have improved quality as well as productivity in cancer care.
national health executive May/Jun 11 | 17
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