25 OCTOBER 1963, Page 19

libi mmi Letters Doctors' Dilemmas C. G. Elliott Tories at Blackpool

John Bea van Rape of the Glens Hamish Campbell Lawyers' Loot Robert McKinnon How to Protest William Rushton Better by Bus M. D. Bianco, A. S. B. Glover Maintaining Contact Miss Helena Broun Dr. Erhard's Home Town Max Gutmann Back to Back Mrs. M. J. Baylis Non-Loo Professor E. G. R. Taylor Lincoln Said It Stuart Miall

DOCTORS' DILEMMAS SIR,—Kenneth Robinson, in his article on the Annis Gillie report on General Practice, is kindly and well- intentioned and yet a GP may be forgiven for finding it an echo of many such vague and slightly evasive statements from politicians.

The GP's worries are not neurotically unreal; they are, as the report bluntly states, about overwork, at times of gross and scandalous overwork. He also worries about his almost complete separation from modern, scientific medicine.

Mr. Robinson states that there has been no de- liberate policy to exclude GPs from hospitals. The fact is, however, that no GP specialist appointments are made, and his Cottage Hospitals are mostly down for closure. How deliberate can you get? To suggest that GPs get work taken from them by in- creased facilities at hospital Out-patients is just not true. Modern medicine demands a tremendous amount of Outepatients' specialist investigation and all patients now expect middle-class standards of medicine, but the heavy work load involved in this falls on the GP as well as the hospital. As regards hospital In-patient facilities, these now put up a 'House Full' notice for the chronic sick in the winter, throwing an enormous and distressing burden on the GP.

He believes that the solution for GPs is group practice, a hardy annual with the politicians since 1948, as if being in a partnership will somehow decrease the work per doctor. Very often the re- verse is the case. How many large partnerships have one or two elderly GPs carried by the younger Ones? As for group practices solving the locum shortage, does he realise that with a practice of say six partners,, and one at a time being away on his summer holiday, the ones left behind will have to do extra work all the summer? Group practice cer- tainly has some advantages, i.e. sharing of ancillary help, but how can they possibly be organised in rural areas?

Mr. Robinson does, however, come out for a change in the reimbursement of practice expenses. This is fine, but does he advocate finding the neces- sary funds to provide equipment and premises appropriate to this day and age? The bill will cer- tainly not be small, for most doctors practice under nineteenth-century conditions. He does well to stress the need for maintaining recruitment for General Practice, as overseas emi- gration of young doctors, seeking greater financial rewards and more skilled work, still seems to be heavy.

The recommendations of the Annis Gillie report are not new and have been put forward many times before, but what is needed is to implement them. Unless the public is told the unpleasant truth that the NHS sacred cow has been seriously under-

nourished since birth, and that only stepping up, perhaps doubling, its diet, will put it back on its feet, nothing can or will be done about General Practice. Meanwhile, like a lot of other public servants of the NHS, the GPs will just have to shoulder their burdens, not the least of which is being blamed by

the public for the present state of affairs.


Rosemount, East Hoathly, Lewes, Sussex