Letters: Erosion of GPs' responsibility


Erosion of GPs' responsibility carries risks for patients

Sir: My heart goes out to Angus MacKinnon and his son Joseph (Extra, 10 October). I hope that I am able to empathise with the impotence he must have felt over that fateful weekend in 2005, as his partner became increasingly ill. I certainly share his concern that many others are even less able to influence events , or seek redress, if medical services go catastrophically awry.

I believe that the origins of the problem go back a very long way. It was considered poor practice to delegate 24-hour responsibility in the 1980s. Some, usually inner city, practices did but the professional responsibility to provide an adequate and continuing service remained with the doctor (named individually) with whom the patient was registered. If a deputy required access to records or other information and this was unavailable the delegating GP was held professionally responsible.

Further abrogation of GPs' 24-hour responsibility continued over the last two decades and the new GP contract of early 2005 only formalised the changes that had already occurred. I do understand that there are advantages in the new arrangements - better equipped and less tired GPs - but continuity of care has undoubtedly suffered. This can be critical as events gradually unfold. The greatest risk of a "team" service is that of diluted responsibility. The British people must realise that gaining satisfaction from "out of hours" services is now akin to using an anonymous call centre instead of a limited but humane "corner shop". I do not want this analogy to belittle the enormous difference in consequences.

I cannot offer a solution but beg politicians (in Parliament and my own profession) to listen to the concerns of those at the front line - GPs and their patients. The "top down" reforms of the last two governments have sapped the morale, professional goodwill and stamina of those in primary care who entered the profession out of vocation and have rewarded those who are primarily business orientated.



The veil is not an Islamic requirement

Sir: I am not sure what the furore is about the veil. There is no such thing as a Muslim veil. A veil is a piece of cloth some women use to cover their face. It has nothing to do with religion.

During the pilgrimage in Mecca the women are forbidden to cover their face or wear a veiled ihram - the pilgrimage robe. (Hadith al Bukhari 25:23). Women offering prayers, whether in private or in a mosque, should uncover the hands and face.

There is no injunction in the Quran stating that women should cover their face. All that the Quran says (Surah XXIV, verses 30 and 31) is that both men and women "should lower their gaze and guard their modesty". Working women, whether as domestics or in public, in most countries where there is a large Muslim population, have of necessity to work unveiled.

The veil is a cultural norm, a custom in some countries. It is claimed by those who do not know, or who do not wish to know, that it is the religion of Islam which prescribes that women should be veiled. This has never been so.



Sir: One point that disturbs me in the letters about Jack Straw's remarks are those claiming that he is telling others "How they should dress" and that his remarks are comparable to telling women "not to wear a blouse". How far are these people missing the point? Do these people really see the face as just one more blob of flesh, perfectly equatable with an ankle, a navel and mid-riff, or an armpit for that matter.

The face carries meanings of personality, individuality, personal worth and, yes, personal veracity and reliability. The two latter are of course deeply connected, each substantiating the other. To be "faceless" questions all of these - and profoundly questions where one places women in the scheme of human worth,reliability and personal responsibility.



Sir: I fully support Jack Straw's comment on veiled women. As a woman I equally feel uncomfortable talking to a woman who is veiled.

Last year in Brixton a veiled woman with two children asked me for directions. I struggled to talk to her because I could not see who I was talking to. When we communicate we use facial expressions as part of the everyday encounter. When I ask someone for directions I naturally smile to offer encouragement and show my friendly intentions. If I am talking to a veil there is no smile, no reaction: communication is one-sided.

If I am ever approached by a veiled woman again I will also ask her to take the veil off for better communication. I think it is courageous of Jack Straw to address the issue, especially since he is not only crossing the barrier of race but also gender.



Sir: Any Muslim in the country might legitimately feel targeted by Jack Straw's latest intervention. The veil signals "difference" says Mr Straw. And what on earth is wrong with difference?

Where I live in Coventry I see each day groups of children going home from school in a wide range of attire, happily laughing and joking. They know who their friends and neighbours are: why does Jack Straw have such difficulty?

It is time to ask why our leaders are using the inexcusable excesses of a tiny minority of misguided religious zealots to demonise the entire Islamic community: it is also time for those of us who are not Muslims but appreciate the multiple human and decent qualities of those of our neighbours who are, to speak out. An assault on the liberties of any one of us is an affront and a threat to us all.



Sir: Judging from letters you have published and from Yasmin Alibhai-Brown's column, the question of veils for women seems to be a subject of vigorous and healthy debate among our Muslim fellow citizens. Unlike the MP for Blackburn, as a non-Muslim I hesitate to enter upon what is evidently an emotionally charged subject.

Meanwhile I am left wondering whether Mr Straw, in his concern for the divisive effect of traditional dress, asks his Scottish constituents to remove their kilts in his presence.



Sir: David Blunkett operates his constituency surgery perfectly well without seeing the faces of his constituents. One cannot help but wonder if that was the only concern of Jack Straw.



Sir: One of the arguments put forward to support a Muslim woman's choice to wear a veil is freedom of expression. When she dons the veil, I am not free to see her expression.



Stop whining about speed cameras

Sir: I'm struggling to reconcile Will Nichol's' "lifetime of law abiding" with his admission that he already has nine (soon to be 12) points on his driving licence due to speeding (letter, 9 October). Does he consider that speeding somehow it isn't a "real" crime?

As a mother who has chosen not to drive, and who daily has to watch as drivers speed past me and my child without any concern for our safety, I am appalled at this attitude. The difference between 30mph and 37mph, while it may seem very little to Mr Nicholls, could be the difference between life and death for any unfortunate pedestrian or cyclist in his path.

I'm absolutely sick of drivers whining about the "unfairness" of speed cameras. The answer is simple, Mr Nicholls: don't speed, and you'll never have to worry about losing your licence, your job, your house. Meanwhile, grow up and stop expecting the rest of us to feel sorry for you.



Romanians stand up for their principles

Sir: In "A gold-rush tale of greed and despoliation" (5 October) Deborah Orr painted a very bleak picture of Romania.

Yes, Romania is poor. Before the Second World War the country was vibrant and cosmopolitan, but the infamous swap between Stalin and Churchill saved Greece from Communism, but delivered Romania to Soviet rule. Decades of oppression followed, with the destruction of all its assets, most importantly, of its élites. But, despite this wretched start, Romania is improving significantly, with rapid growth of 7 per cent per year.

Yes, lots of Romanians work abroad, some in humble jobs, some less so. This has been true for lots of countries at difficult times in their history. Hopefully, these Romanians will bring back money and skills.

I am immensely proud of the organisation Alburnus Maior. It opposes the Canadian mining company Gabriel Resources. Some locals oppose it for ecological reasons, some for archaeological (the local mines are among the oldest in Europe), some for ethical reasons (moving cemeteries is a sacrilege in a culture that respects its ancestors as much as the Romanians do).

It is easy to have and live by your principles when you are comfortable and live in a prosperous and stable environment. To do so when your livelihood is in question is far more difficult and admirable.



Prisoners' children can prevent crime

Sir: Armley prison in my constituency has struggled to cope with overcrowding (Steve Richards, 10 October) for two decades. Every day 50 new prisoners are locked up and 50 are released. The key issue is how to stop them being the same people.

Research shows that if a prisoner receives six or more visits from his child or children his reoffending rate drops off spectacularly. Over 50 per cent of prisoners have young children. Joining up access to their children with learning to read to them (including putting children's stories on tape, CD or iPods) can have a real impact on reoffending.

Home Office support and encouragement of such modest and inexpensive projects would make a real difference. Armley is already trying it, supported by the voluntary Jigsaw project for prisoner families. It is one pilot scheme that should ignite the whole system before it is snuffed out in a crude debate summarised as popularism versus liberalism. Prisoners can be changed by their children.



Blooms that make a desert

Sir: Your excellent newspaper carried two major environmental stories on successive days but sadly missed the link between them. On 3 October you described how the flowers which are available in Europe all year round, the bulk of which are gown in Kenya, at Lake Naivasha, may in future be supplied from Ethiopia. On 4 October you described a prediction that one third of the planet could be desert by 2100 and featured the northern Rift Valley.

Flower and vegetable growing for Europe is the major cause of Lake Naivasha losing 50 per cent of its water volume (and considerably more of its area) since 1990. If flower growing is to move to an even more arid part of the Rift valley, can we justify buying roses on Valentine's day when their water has been sucked from the mouths of Ethiopian babies?



On Bush's target list? - Get a bomb

Sir: May I add my voice to the throng of condemnation about the nuclear test in North Korea? Mr Bush is to be thoroughly condemned for making this more or less inevitable.

You do not have to be an "eccentric" leader to realise that if you were named by Bush along with Iraq and Iran as part of the axis of evil, then if you have not got weapons of mass destruction you had better get them pretty quickly.



End prohibition

Sir: Most of the points made in favour of legalisation of organ sales (report, 6 October) could apply equally to licensing of brothels and the legalisation of drugs, with much more beneficial results to the community at large.



The Amish example

Sir: Your report on the Amish community (5 October) tells how two of the young girls offered themselves to be shot first in the hope of saving the others, how within hours a member of the Amish community called on the killer's family to offer consolation, how the killer's widow was invited to the funerals, and how the community has forgiven the murderer. This heroic behaviour is in total contrast to the mass killing spree in Iraq that was the American and British reaction to the 9/11 atrocity. We should be shamed and humbled by the Amish example.



Marmite's best friend

Sir: As far as I am aware, none of your correspondents have commented on the popularity of Marmite among our canine population. My golden retriever puppy came with instructions from her breeder to mix her meat with Marmite gravy, and to allow her treats of Marmite soldiers. Two years on, she has just produced a litter of eight beautiful pups, all of whom can look forward to being brought up on Marmite.



Homograph horrors

Sir: Julien Evans (Letter, 7 October) cries: "Abolish apostrophes. If they're not detectable in spoken language, why are they deemed essential in the written form?" The written form contains many homographs, words different in meaning and with different pronunciations according to meaning, but that look alike on the page. Consider the difference it makes to the meaning of the following sentence if you add an apostrophe to the end of the first word: "Residents refuse to be put down chutes."



A 'potted plant' writes

Sir: Jacob Rees-Mogg's comments (report, 5 October) simply confirm what is self-evident to those state-educated people like me who inhabit the primordial swamp of human intellectual existence: that the principal purpose of an English public-school education is to instil into people an almost effortless sense of supremacy. It has clearly worked in his case.



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