Sir. Whilst there is obviously a deal of truth in
the facts presented by Dr Linklater regarding the collapse of the NHS (January 6) his rose-tinted generalisations about general practitioners cannot go unremarked.
As sole health visitor attached to a group of three practitioners, I spend my entire working week slap in the middle of the downtrodden conditions Dr Linklater describes, and many of my colleagues do the same. The blunders which have doubtless taken place in hospitals are the result of acute staffing difficulties; the blunders within general practice are not.
No one denies that there is a nucleus of daily misnomers, but if the practitioner would use his ancillary staff correctly, these could be negated from the start. Family woe and marital stress are not so far removed from clinical medicine as Dr Linklater would have us believe; would that they were. They do, in fact, pigeon-hole very effectively under 'Preventive medicine,' which is what my daily grind is all about, and what so many complaining practitioners seem unable to get the hang of. The majority of general practitioners, I fear, do not want to be wrapped up in a cosy little Health Centre with all mod. cons., even if it means less worry about the overheads or that they can arrange to get to the football match when they would usually be doing a smear clinic. They want the privacy of their own sanctums, all sins unseen, glory to the senior partner in the highest, leave him to his private patients and insurance work, and there just might be good will to all men. This usually means that the ' middling ' partner refuses to be lumbered, and the junior one is.
If you want a visit, you will have to describe your symptoms to a clerk, who may well offer you her own advice if she doesn't feel they warrant a visit; if you wing in after nine in the morning, you've more or less had it anyway. Evenings and weekends are definitely out, so you might as well phone ' emergency' to start with. If Dr Linklater wants to complain about money, so do I, but surprisingly enough, not on my own account. I am sick and tired of being asked to arrange for convalescence or the use of e.g. the Saturday Fund, only to find after a deal of arranging, that Doctor, the inceptor, refuses to sign the necessary form until somebody decides how much he should be paid by the NHS for this extraneous duty. By the time the whole thing is wrapped up, the patient is organised and past caring.
As for the practitioner having insufficient time to practise his skills, that is laughable; I have seen patients requiring the odd stitch in a finger, have to travel four miles by bus to the nearest hospital, having been turned away from the surgery where doctors are sitting chatting.
It isn't a surfeit of work that ails our general practitioners, I fear, but an incipient neurosis which left unchecked may well blossom to a persecution complex; it seems salutary to reflect that the suggested nominal fee might act more as an increased incentive to the practitioners thw a deterrent to the malingering patient.
Name and address withheld
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