Letter: The two-tier NHS is here

Sir: I am unable to remain silent any longer about the hypocrisy of the Government's reassurances about the state of the National Health Service.

I am a consultant anaesthetist working in a university teaching hospital. Part of my work consists of outpatient consultation and treatment for patients with chronic pain. Budgetary constraints upon both purchaser and provider have led to a reduction in the number of patients my consultant colleague and I are able to treat. I have today been advised that henceforth I should prioritise new outpatient appointments according to whether the referring general practitioner is a fundholder, rather than solely on clinical criteria.

I do not seek to blame the Southampton University Hospitals NHS Trust management for their advice. If the NHS is to be run on a competitive internal market basis such a policy is inevitable, and indeed we now have differential waiting lists for other medical specialties within the trust based on the same criteria.

I challenge Stephen Dorrell and Gerald Malone (some of whose constituents are referred to me) to deny that this represents a two-tier system of medical care, based not upon the patient's ability to pay, but rather upon the GP's ability to pay. Patients have a right to know this.

Dr DIANA BRIGHOUSE

Southampton