Letters: How changes in primary care turned the health service upside down

SIR – I used to be a country GP. Looking at the reasons patients are now attending A&E (Letters, January 4), I would estimate that about 70 per cent of these cases would once have been dealt with at the surgery or at home, both in and out of “office hours”.

I used to deal with minor accidents, assess acute chest and abdominal pain, and deliver babies. GPs were later able to leave the burden of out-of-hours work behind, and are now very unlikely to return. A&E services are having to adapt at every level.

Dr Nigel Garbutt
Minsterworth, Gloucestershire

SIR – I am a retired GP. In the 27 years that I was a partner in a practice, there was a wholesale transfer of the management of long-term conditions (such as diabetes, asthma and heart disease) from secondary to primary care. This was clinically appropriate.

The Quality and Outcomes Framework was designed to support that work, but gradually became a way of imposing ever more targets on primary care. More recently the transfer of other work (such as post-operative follow-up) to primary care has not been accompanied by sufficient funding to pay for, among other things, the extra staff required.

The role of the GP has changed dramatically in the past 25 years, way beyond simply being “a filter in the community” (Letters, January 4). In the late 1990s it was not unusual for me to work a full day, be up all night visiting patients, then work the next day. By the end of such a day I was arguably not safe to drive, never mind make important clinical judgments. The decision to allow GPs to give up the 24-hour commitment was driven by a recognition that the previous arrangements were unsustainable.

Nonetheless, all the GPs I know today are working harder than ever, trying to provide the best care they can in extremely difficult circumstances. The fundamental problem is that the whole NHS is being asked to do much that it was never originally designed for, and is not fit for purpose in its current form. This is not the fault of clinical staff.

Dr Andrew Inglis
York

SIR – When I was a committee member of the Association of GP Hospitals in the 1980s and 1990s, we protected the interests of 400 such hospitals in England and Wales.

These establishments looked after patients not requiring specialist treatment in district general hospitals. They were local, efficient and cost-effective, and many had 24-hour casualty departments. They provided a solution to “bed blocking” and kept vast numbers away from A&E. Sadly, successive administrations failed to recognise their value, and it became a struggle to keep them open.

The Labour GP contract of 2004 put the nail in the coffin, with GPs leaving work at 6pm and becoming inaccessible at weekends. The end result is what we see today.

Dr Ian Reekie
Chipping Campden, Gloucestershire

Desperate high streets

SIR – Philip Johnston (Comment, January 4) is indeed correct that high streets are in terminal decline and 
no one is doing anything to stop this.

It is obvious that business rates need to be adjusted to level the playing field and reduce the huge advantage that online retailers enjoy. However, the Conservatives have shown themselves to be anything but the party of the local, entrepreneurial retailers who are so crucial to a vibrant town centre.

No wonder these people are giving up their long-held dreams, shutting up shop and probably looking to work in the public sector, where it appears every day is a pyjama day with a gold-plated pension.

Charlie Bladon
Cattistock, Dorset

SIR – Local councils are dissuading would-be high street shoppers by making their journeys almost impossible.

Most villages do not have a decent bus service, so the only option is the car. Yet in Norwich over the past 10 years we have seen ridiculous new traffic systems, pedestrianisation and ludicrous car-parking fees. Traffic that used to flow now bottlenecks. With thousands of new houses being built, this will only get worse.

Sylvia Smith
Norwich

Honours for sport

SIR – I cannot agree with John Dickinson’s assertion (Letters, January 2) that cricketers and other highly paid sportspeople should not qualify for honours.

Having played cricket for many years, I can assure him that sport can be of immense value throughout a person’s life. It provides the basis for a healthy lifestyle – and, if you are good at a sport, doors will open wherever you go.

We need people who can stimulate an interest.

Michael Sanders
Knebworth, Hertfordshire

Public school snub

SIR – In Ed Cumming’s “Everything you need to know about Prince Harry’s choice of TV interviewers” (Features, January 4), Tom Bradby’s wardrobe is described as “standard minor public schoolboy”.

Sherborne is not minor. Is Mr Cumming making a dig at the school, or does he need to do more research?

Robin Price
Taunton, Somerset

Sunak’s maths plan

SIR – Rishi Sunak, the Prime Minister, wants all pupils to study maths until the age of 18.

He is perhaps confusing mathematics with numeracy. A qualified accountant, I worked as a senior financial manager in a multinational company, which relied on volumes of data to run its business.

The numeracy I needed to do my job was acquired at primary school, in the days of the rote learning of tables and long division. My A-levels (maths, further maths) and my degree in maths at King’s College London, though interesting, had little to do with numeracy, which is the ability to make sense of a page of numbers.

Richard Jenkins
Beaconsfield, Buckinghamshire

SIR – Rishi Sunak wants to put maths at the heart of his new strategy for Britain.

Is this so we can better assess the white elephant that is HS2, or the billions wasted in defence procurement? Or is it so that we can better count the hours or days we sit in A&E, the days or weeks we wait for GP appointments, or the weeks, months or years spent awaiting treatment?

Mike Tugby
Warminster, Wiltshire

SIR – Mr Sunak’s proposal is perhaps more a reflection of the present standard of maths reached by many at GCSE level.

With just an O-level in maths, I went on to study geography, history and English at A-level, then qualified as a surveyor. Stopping maths lessons at 16 represented no hindrance for me, in or out of the workplace.

James Thacker
Tanworth-in-Arden, Warkwickshire

SIR – Some people have absolutely no aptitude for mathematics, and their time would be better spent improving their grasp of language.

The present situation is not helped by the fact that highly skilled mathematicians do not often enter the relatively low-paid teaching profession – and, if they do, many are unable to convey the intricacies of this difficult subject.

Fiona Wild
Cheltenham, Gloucestershire

Long-lived shoe polish

SIR – Anne Jappie (Letters, January 3) asks: “What sort of shelf-life does shoe polish have?”

My late mother, who had been a German refugee, taught me to waste nothing. She died in 1998, leaving a fine collection of shoe polishes, most of which are still useable.

Dry tinned shoe polish can be revived by heating its tin on a warm hotplate and then leaving to cool.

Angela Walters
Princes Risborough, Buckinghamshire

SIR – Fret not over Kiwi polish – everything is available on the internet.

Ivan Dunne
Carshalton, Surrey

SIR – Tim Oldfield (Letters, January 3) says you can tell a great deal about a person by his or her shoes.

I was taught by my great aunt that you could tell all you needed to know about a man by his collar and shoes. Very true.

Helen Morris
Haywards Heath, West Sussex

SIR – I started “bulling” boots (Letters, January 4) as an RAF apprentice 60 years ago.

Today I use liquid shoe polish rather than wax. It is easier to apply and eliminates the messy “putting on” brush.

Dave Alsop
Churchdown, Gloucestershire

Where Samuel Beckett learnt to sing hymns

SIR – It was appropriate that Samuel Beckett was recorded singing Abide with Me (Arts, January 3). Henry Francis Lyte, the hymn’s author, was a boy at Portora Royal School, Enniskillen, 120 or so years before Beckett went there in the early 1920s. No doubt the hymn was familiar to Beckett from school as well as church attendance in Dublin. 

Vivian Mercier, the Irish critic who said of Waiting for Godot that “Nothing happens, twice”, followed Beckett at Portora just six years after he left for Trinity College, Dublin. Beckett never agreed to see Mercier, perhaps because he felt he was too familiar with his background.

C D C Armstrong
Belfast

A tall person’s guide to driving a classic car

SIR – Ken Hope (Letters, January 4) regrets that he could no longer get into a Morgan car. I am 6ft 2in and the secret to getting into my Morgan is to leave the roof, down, unless caught in a monsoon-level cloudburst.

Forgetting to wind up the windows is avoided by unclipping them altogether and leaving them in what inevitably becomes the most inaccessible part of the garage. I was prepared for this lifestyle by my previous car – a three-wheeler Morgan, which came without a roof or windows but did have heated seats.

Kenneth Grahame’s Toad expressed the joy of motoring so well, even back in 1908: “Oh, poetry of motion! Ohh, the bliss! Ohhh … poop poop!”

Tony Parrack
London SW20

SIR – After passing my driving test in 1976, I drove a veritable traffic jam of jalopies before buying my (very used) classic Triumph Spitfire 1500cc Mk.4 convertible. The canvas roof and plastic back windows had so many holes that I was constantly taping plastic carrier bags, sponges and bits of old blanket over them as I couldn’t afford a new roof. A child’s umbrella was thrust it into one of the larger holes when it rained, and the back shelf and footwells were invariably awash. I’m sure my girlfriend and I suffered periodic bouts of trench foot.

In the spring and summer months it was all worth it, however: top down, boogie-box blaring, wind in my hair, engine roaring and the open road ahead – motoring magic.

Adrian Stockwell
Farnham, Surrey

SIR – Although no classic, Gigi, our 1933 Austin 7, was certainly romantic.

Painted a startling shade of cardinal red from Woolworths, she certainly attracted attention and many cheery waves as we passed by. With a following wind we could reach 50 mph, which was most exhilarating.

The arrival of the MOT put paid to most of those pre-war cars.

Derek Pritchard
Sharnbrook, Bedfordshire

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