LETTER: A&E wards: conditions that take a toll on doctors' morale

From Dr E. E. J. Martin

Sir: In your leading article (11 January) you fail to mention one of the major factors leading to a shortage of accident and emergency junior doctors in England - the great shortage of doctors training to be general practitioners.

The Royal College of General Practitioners encourages GPs in training to do six months in A&E. However, the number of doctors training to become GPs has fallen by nearly 25 per cent over the past few years.

Recently, more surgery is carried out on a day-care basis, with a patient being discharged on the same day as their operation. Large psychiatric hospitals are being closed up and down the country. In some cases, patients are cared for at home under the "hospital at home" scheme. When these patients are discharged the work that was previously done in the hospital is added to the tasks of the GP.

At the same time, the GP is having to get involved in purchasing the care for his patients. If one adds to this the increased requirements for health screening, the flood of paper now required by the Government about all our activities, the great increase in litigation against GPs and the increased demand for services at weekends and at nights, it is clear that the job of a GP has both changed and expanded hugely.

Young doctors see this great increase in work required of GPs, with no increase in income and a lowering of public esteem in the profession, and they decide not to enter family medicine. It is this lack of family doctors in training which is perhaps the most important factor in the understaffing of our accident departments.

Yours faithfully,

E .E .J. Martin

Bedford

11 January