Letter: NHS shakeup

Sir: Jeremy Laurance fails to understand the nature and value of family medicine in Britain. The Government's proposals for walk-in clinics and the fast expansion of NHS Direct are questionable responses to patients' needs.

The essential features of United Kingdom general practice are the registered patient list, continuity of care, comprehensive care relating to all age groups and across all disease groups and the unified medical record. International evidence indicates that these are vitally important to the cost-effectiveness of the UK health system and to the quality of health outcomes in this country. Countries that provide primary care services without these essential attributes demonstrate fragmentation of care, more expensive care, and often poorer health outcomes.

Health care within a state-funded system with limited resources cannot be made available as if it was a consumer benefit equivalent to shopping at the supermarket. An appropriate level of restraint on the part of individuals in relation to self-limiting and non-serious medical symptoms and conditions is vital. A populist and consumerist approach to the provision of health care is likely to lead to inappropriate care, waste of scarce resources and increased health inequalities.

On behalf of the Royal College of General Practitioners I have spent a considerable amount of time collaborating with the profession and governments overseas in developing primary care systems. It is ironic to find that other countries are increasingly valuing and copying the essential features of our primary care system at a time when our own government, in spite of its rhetoric in support of primary care, proposes untried and unevaluated systems which have the potential to damage and degrade the service.

A more sensible approach would be to provide the additional resources that are clearly available and build on the current success of our system in a collaborative way with the nursing and medical professions.

Dr PHILIP R EVANS

Chairman, International Committee

Royal College of General Practitioners

London SW7