Dr Gavin Francis’s article (‘Voters are unhappier with the NHS than they’ve been for 30 years. As a GP, I feel the same’, 24 August) is a remarkably well-informed, personally witnessed and broad analysis of our NHS problems, and general practice in particular.
Yet the clarity of that view is likely to be lost to successive younger GPs. Dr Francis is in his 50s and has served in the same practice for many years. He is able to write of staff who are familiar to him, and of patients whose stories and experiences he has long shared. He writes with warmth and gratitude of the meaning that such a sense of community has given his own life.
Such blessings are only possible from a bedrock of personal continuity of care, and that is almost entirely lost to the generation of doctors after Dr Francis. Contemporary GPs are now working more like those in a factory or gig economy, where personal relationships or understandings are regarded as irrelevances, or even impediments. Such work has little human nourishment, interest or satisfaction. This is a major reason for the profession’s demoralised crumbling.
Dr David Zigmond
Executive committee, Doctors for the NHS
• Gavin Francis has written an accurate résumé of the NHS and the situation that it now finds itself in, emphasising the key role of the GP as generalist and gatekeeper. I count myself as fortunate, with my practice being hardworking, efficient and friendly. But it was the GPs who fought Nye Bevan up to the inception of the NHS over private practice. Uncertainty about their future then is matched by the uncertainty now of all practitioners and supporters of the service, as again private practice is eating away at the foundations, but on a different tack. References to Bevan and 1948 are not misty-eyed nostalgia; they are fixed navigation points that we can’t stray from in the rough seas of privatisation and Tory neglect.
Jonathan Hauxwell
Crosshills, North Yorkshire
• I was an NHS consultant until 2014, and was born in the same year as the NHS was founded, so while I do not remember healthcare before the NHS, I know from parents and patients that Gavin Francis is correct in his patients’ memories of “keeping a jar of money for the doctor”. But we need not rely on rapidly disappearing memories – in the US, medical fees have long been found as the cause of half of all bankruptcies. There, at least 200,000 families a year suffer a financial as well as medical disaster, something that the NHS protects us from.
Dr John Davies
Lancaster
• Pressures on the NHS arise from a complex mix of factors. Issues of over-treatment and over-diagnosis with a heavy reliance on prescribing drugs as opposed to social prescribing need to be addressed. There is too much focus on the search for quick fixes to complex problems, such as the “skinny jab” for obesity. Many of the demands on the NHS would be preventable if public health was accorded higher priority. This is not about individual behaviour change, but about tackling growing health inequalities upstream, including the commercial determinants of health, which this government seems only too willing to ignore.
David J Hunter
Emeritus professor of health policy and management, Newcastle University
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