‘My son could have flown to Spain and seen a doctor sooner’: your experiences of the NHS in 2022

This year, barely a day has gone by without Telegraph readers discussing their experiences of the NHS. In January, the country was still emerging from repeated lockdowns, designed in part to “protect” the health service. What people found, however, was that the NHS had barely survived. If anything, it was in even steeper decline. 

They wrote in their thousands, telling of inaccessible GPs, cancelled appointments, 13-hour waits. And it wasn’t just patients writing to us. Many of our readers are (or have been) GPs, nurses and consultants – people working at the coalface in exceptionally demanding conditions. Nursing and ambulance strikes have rounded off the year.

Editing the letters page, we’ve had the chance to see all sides of this issue – arguably the most challenging that the country faces. Our readers have diagnosed different problems, and proposed different remedies. But on one point they are unanimous: things can’t carry on as they are.

Hanging on the telephone

January 7

SIR – James Osborne (Letters, January 6) gives an example of management inefficiency in the NHS.

My wife was in three NHS institutions for more than a month, spending Christmas week in isolation, as she had been in contact with a Covid-positive employee.

Last Monday, I was trying to find out where she had been moved to in the Royal Sussex County Hospital, Brighton, after being admitted via A&E the previous day. It took more than 40 phone calls, between 9am and 2.15pm.

The switchboard mostly answered, but when I was transferred to an extension there was no reply. When I did reach a human being, they were unable to help. At one point, I was told that my wife had been sent home. One nurse kindly gave up 10 minutes of her valuable time to physically search for her, but to no avail. I finally discovered that my wife was in the Acute Assessment Unit, almost next to A&E.

The next day, my phone rang from a Brighton number. A doctor or nurse with an update, perhaps? No: it was an automated call asking if my wife (still in hospital) would take part in a survey about her experience in A&E.

David Leech
Balcombe, West Sussex

March 31

SIR – After much difficulty a relative arranged a multi-issue telephone appointment for a mentally and physically vulnerable family member. The call was scheduled for 10am, but it was not taken until 7pm. It was also restricted to one issue, so the patient’s complex needs were not addressed.

At a subsequent face-to-face nursing review it was confirmed that, while a multi-issue appointment had indeed been booked, it had been undertaken not by a GP but a pharmacist, and recorded as occurring at 6pm. The nurse even told the patient that they should complain and change surgeries as “ours is useless” and “all doctors had been working from home that day”.

It is obvious from this example and the many letters you have printed that some GPs are totally failing their patients. Something must be done about this appalling situation to ensure that these handsomely remunerated individuals provide the service for which they are paid.

Adrian Waller
Woodsetts, South Yorkshire

May 4

SIR – Yesterday, I rang my doctor’s surgery a few seconds after 8am. The recorded voice told me that I was “154th in the queue”. After hanging on for 59 minutes, I redialled, only to be informed that all appointments had gone. And GPs want to cut their working hours.

E R Woolley
Stourbridge, Worcestershire 

May 4

SIR – The NHS has decided that painkillers will no longer be prescribed for patients with osteoarthritis. Instead, we are being told to exercise.

I finally received a physiotherapy appointment after a five-month wait, hoping to be instructed on suitable exercises. I have now been told the physiotherapist will be working from home and will telephone me. I am at a loss to know how physical therapy can be delivered over the phone.

Lynne R Wells
Hednesford, Staffordshire

Seeing a GP

April 4

SIR – My GP surgery has a new way of avoiding face-to-face appointments – it has told me to find another doctor.

I have been a patient for 40 years and always lived within four miles of the surgery – 18 years at my current address. The surgery now says I live outside its catchment area, but other members of my family at my address have not been told to leave. I am the only one to have seen a doctor there more than once in the past few months.

Denise Beevers
Yelverton, Devon

April 6

SIR – Like Denise Beevers (Letters, April 4), my husband was told to find another doctor. We had been with our surgery for more than 40 years.

Our dismissal was prompted by a recent request for a home visit, which could not take place as we live “outside the catchment area”. We live 2.8 miles away. A private company contracted to the local NHS trust to provide home visits to patients such as us saw fit to try to call at 1.12 am, and we have been told that even this company cannot now provide us with home visits.

My husband has medical conditions that need constant monitoring. As the surgery fears that he will need to be seen increasingly regularly and home visits are effectively out of the question, we are asked to go elsewhere. Whatever happened to the Patients’ Charter, and “our” NHS?

Jane E Everson
Leicester

April 10

SIR – It is no surprise how discontented the nation is with GP services.

Two weeks ago I had a face-to-face appointment with a nurse for my annual diabetes check. When it was complete she asked if I had any other problems. I told her I was having some bad back pain and she recommended a doctor’s appointment.

She went to the computer and asked if a certain date and time was OK. I agreed and the following Thursday I arrived at the surgery for my appointment. I checked in with the receptionist, who asked me to sit in the deserted waiting room.

A few minutes later she came over to tell me the appointment was by telephone and the doctor would ring me in five minutes. I left the surgery and a few minutes later I spoke to the doctor while I sat in my car, less than 20 yards away. If that is not ridiculous, then I don’t know what is.

Lee Brown
Hyde, Cheshire

May 5

SIR – I am a retired GP working part-time in an A&E department in central London.

At least 90 per cent of the patients I am seeing have been unable to contact their GP, have not been able to get an appointment or have been sent to us with conditions that, in the past, would have been managed by their GP.

This means that the taxpayer is paying me as a locum-rate doctor for my assessment as well as the GP who declines to do their job properly.

Dr Gregory Tanner MRCGP
Middlezoy, Somerset

June 9

SIR – On Friday morning my daughter telephoned our local surgery about a poorly toddler. A recorded message informed her that the surgery was closed for the four days of the bank holidays. How can this be acceptable?

It is no wonder that hospital emergency departments are overrun.

Rosemary Bowskill
Skipton, North Yorkshire

August 26

SIR – Professor Sir Stephen Powis (Letters, August 25) exhorts us to “come forward” to the NHS. I have done so with the following results.

1. An upper gastrointestinal endoscopy for the investigation of anaemia (and possible cancer) has an “urgent” waiting time of 42 weeks.

2. In the investigation of peripheral neuropathy, the waiting list is indeterminately long, and 40 per cent of neurology referrals are rejected in favour of “advice”.

3. In the investigation of urinary retention, despite “rapid access” referral, a delay of six weeks has had disastrous consequences.

Coming forward is the easier part, despite inordinate delays in GP access. A health system “free at the point of use” is useless if inaccessible.

Dr David Abell
Portsmouth, Hampshire

November 24

SIR – I notice that the Care Quality Commission has decided that 96 per cent of GP practices are “good” or “outstanding”. How can this complacent assessment accord with the experiences of patients?

The CQC deals with process rather than clinical excellence. I never met an inspector when I was a GP.

Dr Peter Hard
Pulborough, West Sussex

Cancer

July 3

SIR – A major problem with early cancer diagnosis in this country appears to be that GPs – gatekeepers of referrals for diagnostic tests – are reluctant to make referrals, preferring to treat the symptoms as more minor diseases. Theresa Whitfield (Features, June 30) was fobbed off twice and had to demand a private referral before her bowel cancer was diagnosed.

My mother’s pancreatic cancer was treated as a stomach upset and my father-in-law’s stomach cancer was treated as a hiatus hernia. In both cases they were only correctly diagnosed after admission to A&E, when it was far too late. A friend’s brain tumour was treated as iron deficiency and he was about to use his private medical insurance to see a neurologist when he suffered a seizure. Again, he received a correct diagnosis on admission to A&E.

If it is possible that the cause of symptoms is life-threatening, this should be ruled out by an appropriate test before it is assumed to be a less serious problem. Ideally, common diagnostic tests should be available at local health centres rather than requiring referrals to major hospitals. 

Only when cancers are identified early will the survival rate in Britain match those in comparable countries.

Roger Jackson
Stockport, Cheshire

September 1

SIR – Your Leading Article (August 30) reflected my own recent experience.

Two weeks ago, I popped in to my GP’s reception to ask whether I should see a doctor about a scab on my forehead that wouldn’t heal. Amazingly, I was given an appointment two hours later.

A locum GP examined it and said he was referring me for an “urgent” appointment at a local hospital. He told me that, if I had heard nothing within 14 days, I should return to the surgery.

The following day I received a message inviting me to download an information leaflet about melanoma, emphasising how important it was to keep the urgent appointment in order to rule out the risk of cancer. Two weeks later, having heard nothing, I returned to the surgery and spoke to the same receptionist, who advised me that the information on “urgent” appointments had been updated and the wait was now six weeks.

When I said this was ridiculous, she asked me if I had any private health insurance. I have – but if I wasn’t worried before the GP appointment, should I be worried now?

Stan Underwood
Barnt Green, Worcestershire

October 1

SIR – Lynne Stewart’s husband (Letters, September 29) has had to wait four weeks for his scan results from the oncologist.

It could be worse. I had a scan on September 24, and my telephone appointment to get the results is scheduled for November 7. Such waits are not uncommon: many cancer patients in an online support group to which I belong are also experiencing them. The NHS is struggling to cope.

Waiting takes its toll on both the mental and physical health of patients. In fact, in my support group, we refer to it as “scanxiety”.

Sally Bennett
Hereford

“Due to Covid…”

January 15

SIR – One of my elderly parishioners was very recently diagnosed with a terminal illness and taken to our local hospital. They had no next of kin, and a kind neighbour was the sole designated visitor.

My parishioner loved our church, and received great comfort from his faith, particularly in receiving the Sacrament. Knowing he was so near the end, I rang the ward to ask if I could visit him. I am triple-jabbed, as was he, but a visit was not allowed.

Fortunately, his neighbour is a person of faith who could comfort him, yet it would have been such a blessing had I been allowed to give him Holy Communion as his parish priest.

When will the NHS realise that, even in the current situation, spiritual health is important and life-giving to many people? The drawbridge approach in so many aspects of our health service is deeply depressing.

Rev Michael J Maine
Cuckfield, West Sussex

May 2

SIR – I write this outside an A&E department where we have just been forced to abandon my 82-year-old father, who has fallen and hit his head, because patients may not be accompanied.

This, in the week where Parliament heard that hospital and care home visiting restrictions are “cruel, inhumane and unnecessary”.

Our caring NHS? What a joke.

Stephen Sanderson
London SE8

Paper trails

October 13

SIR – Is the NHS in a mess, by any chance? My audiologist recently referred me, via my GP, to the local ENT hospital clinic for further checks. So far, I have received five letters from the NHS Trust to confirm this.

John Tilsiter
Radlett, Hertfordshire

October 29

SIR – I have just received in the post eight letters from the NHS confirming an appointment I have for Monday October 31. Can any readers beat this?

Cynthia Denby
Edgware, Middlesex

November 7

SIR – On Saturday morning my husband received two identical letters from the NHS.

Both had been posted first class, but from different locations. The letters were to inform him of an appointment on June 22 2023.

This had happened before. It is not difficult to identify some of the savings that the NHS could be making.

Yvonne Moffatt
London SW3

November 28

SIR – I recently had an extremely uncomfortable outpatient procedure carried out without pain relief at my local NHS hospital after being given a cancellation slot.

When I returned home I found a letter waiting for me from the surgical short-stay unit of the same hospital offering me an appointment for exactly the same procedure – but under general anaesthetic.

I later discovered that the outpatient service and the surgical unit did not share the same computer system, hence the duplication. I have a sneaking suspicion that the patient who cancelled the original outpatient appointment had discovered there would be no pain relief.

June Irlam
Cranleigh, Surrey

Chaos in hospitals

May 10

SIR – My recent experience of the NHS has left me in despair.

On February 25, after a face-to-face GP appointment, a chest CT scan was requested, but was refused by the hospital. So, on March 14, the GP sent the request to a different hospital.

Last week I contacted the second hospital to check that the request had been received, only to be told that it was “on hold”, as the hospital needed to see my chest X-ray first. I had not been asked to have a chest X-ray. I was promised a follow-up telephone call, but to date I have heard nothing. Now the department is not answering calls.

No wonder patients are presenting with advanced diseases.

Pamela Cox
Lichfield, Staffordshire

November 4

SIR – I am a retired consultant anaesthetist who has stayed on, first during the pandemic and now to help deal with the backlog of NHS patients.

I recently provided cover for an orthopaedic list at my former place of employment – of which I had fond memories, not least for its efficiency.

The first half hour of the list was spent trying to find out why the equipment requested more than a month ago was nowhere to be found. The next half hour was spent trying to find out why there was only one radiographer for six theatres, which needed support for all or part of the day.

While another radiographer was sought, a pattern of disorganisation emerged. One list was cancelled as there was no surgical assistant; another because the head support for the operating table could not be found; another because the kit for a six-hour operation did not arrive until mid-afternoon.

Meanwhile, we managed to get a radiographer from a nearby hospital on the grounds that our patient had been cancelled three times, and his only twice. When he arrived we discovered that our patient had not stopped taking her blood-thinning tablets – and so, as her blood would not clot, she was inoperable that day. Our last patient got her operation, but it took two hours instead of 30 minutes because we lacked the correct toolkit.

Staff and colleagues alike seemed completely demoralised and said that this was little different to any other day. I had two clear impressions: first, that no one was in charge (at no time were any management figures seen). Secondly, I am wasting my retirement.

Dr S D Jones
Manchester

Emergency care

February 14

SIR – The NHS is encouraging more people to dial 999 if they experience symptoms of a heart attack. After I had a heart attack on February 4, my wife rang the emergency services at 5.50am and was told that an ambulance would not be available for at least an hour.

Fortunately she had the good sense to call our son (a copper) and his girlfriend (a paramedic) who got me to Royal Stoke Hospital, after 75 wasted minutes waiting for an ambulance.

What is the point of creating more work for an already over-stretched service if, as one would expect, this rallying call creates more call-outs from over-cautious individuals?

Fortunately (and obviously), I survived, thanks to the speedy action of hospital staff once I eventually got there.

Iain Findlay
Audlem, Cheshire

April 2

SIR – Here is a brief account on my recent experiences of some sadly incompetent parts of the NHS.

I suffered a minor stroke on March 2. My family recognised this and rang 999 to be told that no ambulance was available for several hours. My son came and drove me to the emergency department, where treatment was swift and exemplary. So the ambulance fleet manager needs investigation.

Three weeks later I received a written invitation to an appointment at the hospital. As I was unable to drive, my daughter drove me the 18 miles to Exeter. On arrival I followed the detailed instructions in the letter.

I found the clearly labelled Area E, Level 2 only to discover it is now the Major Incident Centre and not what I was expecting to find. Following the next instruction in the letter, I then went to seek the “Stroke Unit Reception Office” only to discover that there is no such thing.

I eventually found the stroke ward and learnt from a helpful nurse that the appointment would by telephone – a fact not mentioned in the letter. The nurse said it was a “secretarial error” and that I was “not the only one” so misguided.

I was then promised by telephone that a letter would follow about another appointment. I asked how I could verify the accuracy of its contents and received no comfort.

It seems that only time will bring a cure. I do hope, if we taxpayers are to pour even more money into this service with so many inept departments, that a root and branch survey will weed out the incompetents who now seem to be in charge.

Roland Ebdon
Honiton, Devon

April 16

SIR – My 80-year-old next-door neighbour fell and was unable to get up unaided from his stone kitchen floor.

His wife, who was unable to help him, phoned 999 for an ambulance and was advised of a 13-hour wait. She came to me for help, so I rang 999 and an unsmiling ambulance crew arrived within 20 minutes.

As a retired GP I was able to provide information necessary to expedite the recovery of this gravely injured man.

The current algorithm-driven telephone triage system seems to be insensitive to the actual and immediate needs of the patient.

Dr Richard Bell
Kinsbourne Green, Hertfordshire

July 25

SIR – Recently a 38-year-old family man had a severe reaction to a bee sting at our home. His face swelled, he could no longer breathe through his nose and his throat was tightening.

The 999 operator, after a lengthy discussion with his manager, told us the wait would be at least eight hours. My wife (a retired GP) and I confirmed that this was a life-threatening emergency. The operator apologised and suggested we transport the victim to Accident and Emergency.

Rather than risk A&E – seven miles in rush-hour traffic – I drove him to our local health centre as my wife phoned ahead. He got the vital adrenaline injection in time.

The NHS always had its flaws but until recently the assumption was that its response in an emergency could be relied upon. Our experience supports growing evidence that this is no longer so; a frightening paradigm shift. If this milestone does not encourage appropriate action, what will?

Brian Simpson FRCS
Dinas Powys, Glamorgan

August 23

SIR – On a recent Sunday my son, aged 36, having called 999 and got no answer after seven minutes, phoned his parents to take him to A&E in Swindon. He was concerned he was having a heart attack. We drove to his home and took him to hospital.

A sign said the wait time to see a doctor was five hours. Staff at reception said it would probably be seven. He was eventually given an electrocardiogram and saw a doctor after eight hours. The outcome: “You need to see a cardiologist”.

My son said he could have flown to Spain and seen a doctor in less time.

Charles Steward
Chippenham, Wiltshire

August 27

SIR – I recently had a fall and damaged my left hand. After a couple of days the ring finger had become quite swollen and discoloured and I decided that the ring had to be removed.

I phoned my GP surgery to ask if it had the equipment to cut the ring. The receptionist was uncertain and sought advice. The answer was no, and that I should go A&E. However, the thought of waiting 24 hours was unattractive so I phoned the local jewellery shop and asked the same question. Yes, the member of staff said, of course we do. A short trip later – job done. Payment, not necessary, sir. Pleased to help.

Malcolm Ilett
Bedford

Blood shortages

October 13

SIR – I have donated 141 pints of blood and agree that the current shortage has been “years in the making” (report, October 13).

It has become increasingly hard to donate. If you are lucky enough to find a centre nearby, the chances are that there won’t be an appointment you can book (the only way to donate since walk-in centres were discontinued).

If you are able to get one, woe betide you if you are late. I was on one occasion, due to traffic, and it was a real struggle to persuade the staff to let me give my precious A negative blood. Fortunately for the eventual recipient, I succeeded.

Carol West
Welwyn Garden City, Hertfordshire

October 14

SIR – I was a regular blood donor but stopped doing it after four out of the last six booked sessions were cancelled at short notice (three of them while I was actually on the way there).

I complained but was fobbed off with excuses. If the donations management team holds donors in such low regard, it’s little wonder when we choose not to continue giving.

David Sharrock
Stockport, Lancashire

October 14

SIR – When I saw your report I felt I had to do something. I used to donate, but got out of the habit. I am O negative, the universal donor, which is in such short supply.

I tried to contact the blood donation service – a waste of time. No phone was answered, and I was in an hour-long queue to register online. What a useless response to an emergency.

Dr Paul A Reilly FRCP
Martock, Somerset

Maternity care

October 20

SIR – It is of real concern to see the number of avoidable baby deaths at Kent hospitals, and I suspect this is a widespread problem.

My daughter was booked in to be induced at a London hospital at a specific time last Saturday. It was the due date for her first baby, and there was concern over the baby’s movement. She waited eight hours to see a doctor, who apologised – and commented that the delay was a joke – then agreed the procedure.

After two failed attempts, they decided to intervene, and my daughter was told she was going to the delivery room at 8pm, then 11pm – and then 1.30am. She was never taken there, and was very stressed waiting.

On Tuesday she was told that she wasn’t a priority, and was asked to wait until they were less busy. At the time of writing, after four sleepless nights she is totally exhausted and has returned home until they have space for her.

What sort of service is this for a first-time mother in a highly emotional state who is now overdue by several days?

Sheila Powick
Crook, Co Durham

Elusive dentists

March 3

SIR – Since moving to Devon 15 months ago I have been trying to find an NHS dentist, with no success.

I regard the ability to eat as pretty fundamental. Likewise, I regard the ability to see what one’s eating as an advantage, yet eyecare has long since been privatised.

It would be nice if the NHS paid a bit more attention to basic “quality of life” treatments.

Justice Hawkins
Great Torrington, Devon

Dementia

March 27

SIR – Your report on dementia highlights the number of people with symptoms who have been left waiting for a diagnosis.

I am a doctor, and spend most of my time assessing patients in care and nursing home settings to determine whether they have capacity. It is heartbreaking to see the number of elderly patients who have been in these homes for years without being properly investigated. The term “dementia” is merely a collection of symptoms, not a diagnosis. (It is a bit like a doctor “diagnosing” a headache. It does not indicate whether the patient is suffering from stress or a brain tumour or any of the myriad conditions in between.)

There are many causes of dementia which are reversible, and treatments can give patients a new lease of life. The problem is twofold. First, the secondary services are overwhelmed by the numbers being referred. Secondly, GPs are not undertaking the basic tests that would identify the bulk of suspected cases. Blood tests and a CT scan are often sufficient. During my time assessing patients in care homes, proper investigation has identified two cases of hypothyroidism, three of vitamin B12 deficiency and one of normal pressure hydrocephalus.

It is essential that relatives and best-interest assessors hound GPs and secondary services to ensure that those who are affected, and are unable to speak up for themselves, are not allowed to suffer through lack of interest on the part of a broken NHS. Alternatively, we should acknowledge that the NHS is broken and find a different way to protect these people.

Dr Steven R Hopkins
Scunthorpe, Lincolnshire

May 27

SIR – The nursing home caring for my mother, a feisty 92-year-old former ward sister and district nurse who now suffers with dementia, called me to say she had been diagnosed with terminal liver failure. They wanted to discuss end-of-life care.

Distraught, I pressed for more information. The doctor had apparently conducted an examination by video link. I requested a face-to-face visit, which was refused. The only alternative to the end-of-life care option offered was a visit to A&E. I reluctantly agreed, worried about the distress this might cause my mother.

After 12 hours on a ward trolley, she was diagnosed with a simple infection, which was treated with antibiotics. Three days later she returned to the home and has made a full recovery.

The initial complacency of the NHS has left me speechless. Had my mother been aware of all the shenanigans, on the other hand, her views would have been unprintable.

Michael Gough Cooper
Chiltington, West Sussex 

Notes from the coalface

January 30

SIR – I have been a full-time GP for 25 years and work in a practice where, for months, patients have been free to book directly to see their GP face to face. The waiting time to see me for a routine appointment is currently a little longer than I would like, but is nonetheless a not-too-unreasonable seven working days.

Despite this, last Monday, in addition to the 30 urgent requests for medical attention that were dealt with by other GP partners (alongside their routine appointments), a further 57 requests were received by the practice and passed to the duty doctor. Needless to say no lunch break was taken. The afternoon was a little quieter, with just 42 more urgent requests
for medical attention being received by the practice before it eventually closed at 6.30pm. Of these, 26 were allocated to the duty doctor.

Fortunately I work in a supportive practice team and we all help each other as much as we can. As a result, the duty doctor was not left to cope with this massive workload alone. Even so, as well as dealing with countless blood results, repeat prescription requests and hospital letters (which themselves generated a further eight telephone contacts with patients), the
doctor still dealt with 56 urgent medical problems personally, which included seeing 26 people face to face. It was a 12-hour day.

This unsatisfactory way of working is, sadly, not unusual. Nor is it safe. General practice is working harder now than it has at any other point in my career, and it is not surprising that staff morale is low. This sorry state of affairs isn’t helped by suggestions that it is GPs who are to blame for the difficulties that patients are experiencing getting the care they require.

Dr Peter Aird
Wellington, Somerset

May 2

SIR –Your headline “Our feckless NHS is squandering Rishi Sunak’s tax raid” was insulting and inaccurate.

People throughout our NHS and social care system are moving heaven and earth to recover ground and reduce care backlogs while dealing with the continuing impact of Covid-19.

The pressure we saw pre-Covid across all NHS services has been massively exacerbated by the pandemic. Over the past few months, the NHS has faced a triple whammy of Covid-related challenges: high staff absences, many linked to Covid; more people in hospital with Covid than expected; and significant delays in discharging patients, partly due to Covid’s ongoing impact on social care services.

Yet, thanks to the hard work of frontline staff, ambulance services are working at a level never seen before, with call-outs a third higher than pre-pandemic. With more than 2.1 million A&E attendances, hospital emergency care saw the busiest March on record.

Activity to bear down on elective care backlogs has increased. GP appointments are exceeding pre-pandemic levels. More people have been seen for suspected cancer and more CT scans are being conducted than before the pandemic.

NHS leaders are passionate about improving health outcomes. They do not see the NHS as a sacred cow that cannot be improved, and recognise that transformational change is vital.

But they also know that their frontline staff are as committed as ever and are working flat out for the people they serve. Those staff speak of feeling burnt out and exhausted, but still strive to give patients the best possible quality of care.

Chris Hopson
Chief executive, NHS Providers

Professor Martin Marshall
Chair, Royal College of General Practitioners

Matthew Taylor
Chief executive, NHS Confederation
London SW1

May 8

SIR – The CEO of NHS Providers, the chair of the Royal College of GPs and the CEO of the NHS Confederation say that “frontline staff are as committed as ever and are working flat out.”

In military terms the writers are commenting as staff officers, sitting in their ivory towers and totally removed from what is happening on the frontline. Another way to put it is that their perception does not reflect my reality as an inpatient for 13 days. During my stay I was never seen by a consultant. As a result, my care was dysfunctional and I had to influence it on several occasions.

On admission I did not mention that I was medically qualified, had been a director of A&E, and had been a medical director and chief executive of a hospital. As well as not seeing the consultant, I always saw the nurses and junior doctors independently. Had there been a clear clinical plan the dysfunction would have been addressed. That is what used to happen.

This is not about resources and money. It is simply about care and clear planning.

D W Spence FRACGP
Sheffield, South Yorkshire

July 24

SIR – On the day that the co-operatives started, I told my partners that general practice had died. They disagreed, and joined up to get more time off.

I never joined my local co-operative, as I hated the thought of GPs not having their own personal patients, for whom they were always responsible.

I was proud of my partners and my surgery. Now surgeries are just places of work, like offices, rather than places where all partners know their patients and their partners, and benefit from mutual concern and support.

GPs now miss so much. I quite understand why they are leaving.

Dr Martin Porter
Lenham, Kent

August 31

SIR – Among all the challenges faced by the NHS, little has been said about reduced productivity.

As a cardiac surgeon I was performing up to 350 major cases a year in the 1990s, but by the time I retired 10 years ago that number was around 120.

There were many reasons: a consultant contract (motivated by the erroneous suspicion that consultants were skiving) that decreased my sessions by 30 per cent and increased my pay by 20 per cent; a pension policy that resulted in the risk of actually paying to work extra sessions; the working time directive that reduced the support of trainee surgeons, despite their desire to gain experience; the General Medical Council requirement for revalidation, which, despite the lack of any concrete data that it is beneficial, has become a time-consuming and expensive industry; the necessity to undergo “mandatory and statutory training”, taking front-line staff away from patients; the highly vaunted IT systems, the navigation of which wasted half an hour each day.

The “Blob”, working in committee rooms in Whitehall, divorced from the coal face, may well have thought these initiatives were beneficial – but every one has come at the expense of doctor-patient interactions. We are now seeing the catastrophic results of this approach.

Edward Smith FRCS
London SW20

November 24

SIR – I recently retired from general practice.

When I started, almost 40 years ago, the job was about giving advice. Today, it is necessary to “sell” the same advice and justify it in writing to prevent potential complaints from the entitled customers. It now takes two or three times as long to do the same job, and these increased patient demands have resulted in reduced GP access and longer working hours.

Dr Andy Ashworth
Bo’ness, West Lothian

Strikes

December 11

SIR – Whatever the rights and wrongs of the nurses’ pay claim (report, December 8), it can surely never be right to go on strike at the risk of endangering life.

Yes, nurses have a right to strike, but they also have a responsibility to care for and save the lives of their patients. Surely that responsibility trumps any pay claim.

Mark Calvin
Tretower, Brecknockshire

December 15

SIR – I am an advanced nurse practitioner (ANP), past retiring age but doing locum work for a GP surgery.

I trained on the wards as a registered nurse, with a few weeks at a time out for study leave. It was the best kind of training, as we got practical experience learning on the job and trailed senior nurses watching procedures. We were never short of staff.

By contrast, as an ANP, I once had a student nurse in the surgery who was about to go on the wards. She was very nervous as she did not feel she had enough experience. Nurses do not need a degree. I did mine later in life when I decided to become a nurse practitioner and an independent prescriber. If student nurses spent more time on the wards there would be more nurses available, and they would gain vital practical experience.

Regarding the nurses’ strike, I think nurses should be paid more. I also think that, during the pandemic, when they worked so hard, they should all have been given a bonus of £1,000. It is not too late.

Angela de Caux Feather
London SW18

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