Standards initially rose, and the ablest doctors were attracted to general practice. There were often bitterly disappointed candidates in the 1980s who could not gain access to the official vocational training schemes, which were heavily oversubscribed.
The invention of fund-holding may have been perceived as an advantage at first, but has become bogged down in bureaucracy.
However, this deterioration in conditions was not necessary. GPs could (and many did) decline to join what was clearly intended to be an inequitable system, forming instead non-fundholding consortia to organise resources and access to secondary health care.
It is in all our interest to see the attractiveness of primary health care careers restored, but this must mean undoing the damage of the "internal market" and its hefty administration costs.
Britain has never produced enough of its own doctors, and general practice must suffer if hospital medicine or some other job altogether are seen as infinitely more appealing.
Dr MALCOLM C BATESON
Bishop Auckland, Co DurhamReuse content