Letters: Imagination needed to solve GP crisis

These letters appear in the 28th May issue of The Independent

The crisis in recruitment and retention of GPs in the UK (Letters, 20 May) is becoming ever more apparent. Over the past decade doctors working in primary care have had more responsibilities, and faced increasing scrutiny, criticism and insecurity. The threat of longer working hours and a landslide of paperwork, appraisals and financial restrictions have had a disastrous effect on morale.

The result is not surprising. Increasing emigration and career choices outside general practice, and a rush to retirement among both those over 60, and, alarmingly, younger doctors who have spotted a more attractive alternative.

Clearly there is much to be done to rebuild confidence. The NHS is an extraordinarily flexible organisation and continually reinvents itself, so it should look to its strengths. One of these might be those highly skilled and experienced doctors who have recently retired or are contemplating doing so. Improving conditions for this group might go some way to diverting the recruitment crisis and might have additional benefits.

Flexible working practices (parental leave, training opportunities, improvement in working hours) have gone some way to making general practice more compatible with family and healthy lifestyles. A serious opportunity to make work for those contemplating retirement seem an obvious win-win situation.

Factors preventing doctors continuing to work are often bureaucratic and organisational. Excessive insurance, professional membership and GMC registration fees, unnecessarily complex appraisal processes and deteriorating status are just a few of the reasons why doctors may feel that retirement offers a better prospect.

The US has an impressive tradition of using its ageing workforce as part-time workers, mentors, advisers, consultants, academics with experience and even volunteers.

Here, there is a poverty of imagination when it comes to using the skills and experience accumulated over many decades of professional involvement in healthcare. We should make some effort to learn how a valuable asset can be used rather than lost.

Roy Robertson

GP and Academic (approaching retirement)

Edinburgh

The biggest single “inefficiency” in the NHS is almost certainly perpetual top-down reorganisation, of the kind seen under the Health & Social Care Acts 2003 (which introduced Foundation Trusts), 2006 (which introduced commissioning) and 2010 and 2012 (which introduced Clinical Commissioning Groups and forced these to put more contracts out for private tender).

Even if the government can find the additional £8bn required to fund the NHS, where are they going to find the additional 5,000 GPs required to provide seven-day cover, or the additional nurses and midwives? Already one in 10 GP vacancies are unfilled. It takes seven years to train a new doctor – way beyond the period of the new parliament.

Likewise, the last government reduced the number of nurses in training; as a result, there is now a shortage of British nurses. An increasing number of NHS providers are having to recruit from Spain, Portugal, Italy, Poland, Greece and Romania and outside the EU from countries like the Philippines, India and Nigeria. What is that going to do to the government’s promises on immigration?

Even if the Government could provide additional nurse-training places immediately, it takes four years to become fully trained. In the meantime NHS providers will continue to struggle with recruitment and be forced to continue to use expensive agency nurses and locums – with the NHS haemorrhaging revenue to the private agencies at the expense of service provision.

Julius Marstrand

Cheltenham

Anthony Frank (letters, 26 May), like many others, assumes GPs are medics who have merely completed basic training before going on to specialise. General practice is a specialism in its own right, requiring specialist training just as rigorous as other branches of medicine.

Roger King

St Ives, Cambridgeshire

Constitutional confusion reigns

Sadly the Queen’s speech (report, 27 May) did not go far enough in dealing with the many and various constitutional issues now afflicting the UK. Piecemeal commitments (for example on elected mayors and some regional matters) were made.

However there was no indication that the framers of the speech grasp that the problems in the governance of our country are now so great that only a comprehensive and overarching settlement will do.

We badly need a constitutional convention taking in not only the powers that the various devolved assemblies should have, but also the role of Westminster and methods of election.

Mr Cameron and his colleagues need to start thinking on a much bigger scale if the break-up of the Union is to be avoided.

Rev Andrew McLuskey

Staines, Surrey

Conservatives are blasé about the unfairness of the present electoral system, but become indignant about the redrawing of constituency boundaries when it does not favour them.

The repeated redrawing of boundaries means that many voters are vague or ignorant about which is their constituency.

Conservatives and Labour declare that our system has existed for centuries and has stood the test of time. But for a much longer period representation was by counties and boroughs which had permanent and distinct identities. Each elected two MPs, just as local government wards now elect several councillors.

MPs state that people value having a single representative, even if of a party which they do not support. But surely this suits MPs more than the voters.

Dr Selby Whittingham

(variously in the South Kensington, Kensington or Chelsea constituencies)

London SW5

The idea that more power should be devolved away from London is a good one, but this government is doing it all wrong.

Making one city in an area all-powerful is elitist and unfair on the rest. Surely the answer has to be seven, locally elected, regional governments, that can cater for, and be accountable to, everyone in that region, not just the big-city dwellers. MPs could be elected by areas of a region, and represent their constituency and that region in Parliament.

John Hudson

Derby

How UK legal system perpetuates abuse

I was truly shocked by James Rhodes’ account of the initial abuse he suffered and, even more, by the abuse he suffered as a consequence of the way the legal system functions (26 May). That his life should almost be destroyed and his story silenced by its arcane and dilatory procedures is iniquitous beyond belief.

The Independent is to be commended for giving wide publicity to this story and I hope will continue to highlight the malfunctioning of a system which is not only prohibitively expensive and unnecessarily ponderous, but pernicious in the way that both public disclosure injunctions and libel laws can be used to silence the right to the necessary freedom of expression.

Dominic Kirkham

Manchester

After the Charlie Hebdo tragedy there were weeks of discussion and demos about how free speech is one of the fundamentals of our society.

It ws therefore particularly shocking to read James Rhodes’ account of how his ex-wife, lawyers and the judicial system gagged him from publishing a memoir telling of his horrific abuse as a child. That we live under a system that can silence the press and leave individuals unable to get their story out is very, very scary.

Thank God Rhodes eventually won his case, but the cost emotionally and financially is terrible. For how many others will their stories stay hidden forever?

Sara Starkey

Tonbridge, Kent

How to make bankers behave themselves

Alan Hinnrichs (letter, 26 May) rightly points out the ineffectiveness of corporate fines to deter those financial institutions found guilty of rigging various market instruments.

Leaving aside previously flaccid regulation, and the weak or, worse, absent and poorly policed risk-management systems and controls in those entities, the time has surely come, under the Proceeds of Crime Act, simply to relieve the individuals involved of their primary (and no doubt, secondary) residences, luxury cars and other belongings. I cannot help but feel that such exemplary action would – finally – concentrate minds wonderfully.

Jeremy Redman

London SE6

Your 26 May headline describing as City trader as being “motivated by greed” reminds me of the old rule: “Dog bites man” is not a news story; “Man bites dog”, however, is something else altogether.

Alan Thomas

Epsom, Surrey