Letters: GPs' patient care

Steven Ford (letters, 19 January) is right to bewail the surrender of 24-hour responsibility for patient care by GPs. The profession has lost respect as a result, but more importantly become de-skilled in emergency medicine.

The old out-of-hours service was always patchy; as any junior hospital doctor would have been able to tell you, some GPs were excellent, but many were not so good. Now the requirement seems to be for GPs to devote their time to managing long-term conditions, thus attracting a different sort of person to the profession, one who is office-based, working to protocols and within tangled bureaucratic constraints. The old-style GP of popular imagination, who would tumble out of bed in the small hours to do battle with disease, in his pyjamas, was always a bit of an amateur and has now long gone.

The solution seems to me to train a new form of emergency medical practitioner, based upon the existing paramedics, but with an extended role in prescribing. They would need to be able to recognise, diagnose and manage a comprehensive range of urgent conditions, working both in out-of-hours centres and undertaking home visiting. GPs should then be left to manage chronic disease, which would include a major role in co-ordinating patient care, navigating the increasingly bizarre and tortuous journeys that patients must take when using hospital services, fragmented as they are by super-specialisation and the purchaser-provider split.

GPs, however, should not lose sight of their role in the treatment of acute illness and a major part of their training should be a secondment to this new profession of enhanced paramedics.

Dr Bill Hart

Everthorpe, East Yorkshire

Insanity of our ‘defence’ spending

As a series of disaffected insiders queues up to censure Blair and Brown for denying our Army the protective equipment it needs in Iraq and Afghanistan (“Hoon: Brown is to blame for Army shortages”, 20 January) and war chiefs squabble over who hits the multi-billion-pound jackpot of thetaxpayer-supplied “defence” budget, the herd of Trident elephants in the room all carry 100-kiloton nuclear warheads.

Each of these insanely expensive constructs (the Government is currently spending billions of pounds at Aldermaston just to maintain them) is seven times more destructive than the Hiroshima bomb and each Trident submarine carries 48 of them; sufficient to incinerate around 40 million people.

Our government says that we need to renew this genocide capacity in spite of the cost. (£95bn by Greenpeace estimate). Yet General Sir David Richards, Chief of the General Staff, tells us that the nature of conflict has changed. Today it is “principally about and for people – hearts and minds on a mass scale”. We do not win hearts and minds by threatening to wipe out a substantial portion of the human race.

The people of the UK who supply the military with their funds do not want these nightmare instruments of Armageddon. And our soldiers deserve to be properly protected.

JIM MCCLUSKEY TWICKENHAM, MIDDLESEX

How depressing it is to contemplate the current spat between the heads of Britain’s armed services as they call for more toys for their boys.

While everyone else is contemplating cut after cut (I write as a county councillor looking at the decimation of budgets to help children, vulnerable adults, the generally disadvantaged and anyone who stirs from their front door as a cyclist, pedestrian, car-, bus- or train-user), the service chiefs want huge aircraft carriers, Trident submarines, supersonic aircraft and tanks enough to see off the Red Army on the plains of northern Germany.

If they were to say, “We need less money, but spent more wisely, more realistically and in line with the true interests of a mid-level European country”, we might all take more notice of them.More helicopters, yes.

More investment against cyber threats, yes. More people who would really be useful in Haiti, Sierra Leone and domestic emergencies, yes. But surely not those big-ticket items which hark back to a bygone age and merely make admirals, generals and air marshals feel jolly, jolly important.

SIMON SEDGWICK-JELL CAMBRIDGE

Review of criteria for blood donors

The

criteria across all of the UK Blood Services for accepting blood donors on the basis of virus risk are recommended to theGovernment by the Department of Health’s independent Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) (“Lift the ban ongay blood donors”, letters, 22 January).

In order to assure the continued safety of the blood supply, the current policy is to ask those in groups shown to have a particularly high risk of carrying blood-borne viruses not to give blood. These include men who have ever had sex with men. The reason for this exclusion rests on specific sexual behaviour, rather than the sexuality of the person wishing to donate. There is, therefore, no exclusion of gay men who have never had sex with a man, nor of women who have sex with women.

SaBTO recently began considering new research relating to deferral periods in place for high-risk blood donors, including men who have sex with men. Following this review, SaBTO will make its recommendations to the Government as to whether any changes to the current policy are warranted.

These recommendations will be based on the best and most up-to-date scientific evidence available.

There has been a safe and sufficient blood supply in this country for many years, although the rate of blood donations is subject to fluctuations, which is when we make particular efforts to ask the public – particularly those with rare blood groups – to give blood.

DR SUSAN BARNES CLINICAL DIRECTOR, NHS BLOOD AND TRANSPLANT,WATFORD

Irresponsible to abstain from voting

What a piece of irresponsible nonsense from Keith Farman (letters, 12 January), who wants ballot papers at parliamentary elections to include an option to abstain.

The country has to be governed and the people who wish to record “none of them” on their ballots are on another planet. If Keith Farman is unable to support any of the parties contesting St Albans he has one obvious solution. He can stand himself. That at least should focus his mind on the things he thinks could and should be done. Perhaps he could spell them out for us – fully costed of course.

He should get off his backside and get out and campaign forwhat he believes. Now.

HOWARD COOPER LONDON N9

Why single out Israel’s fence?

Johnny Rizq sees Israel’s proposed fence on its Egyptian border (letters, 18 January) as “evidence of its obsession with building physical barriers”. Some obsession, if it has taken 60 years to think of it!

He does not seem to appreciate that it is only because economic refugees are entering this little country in unprecedented numbers (genuine refugees have been welcomed) that Israel is forced to this measure, just as the intifada and suicide bombers forced Israel to construct the, as yet unfinished, security fence. It is quite interesting that the underprivileged of so many African countries choose just Israel for their future wellbeing and not closer Arab/Muslim lands.

He finds it sadthat Israelis no longer “shop in Palestinian markets or eat in Palestinian restaurants”. I for one am happy to forgo this pleasure in return for the reduced risk of being blown to bits in an Israeli market, restaurant or bus.

It also strange that he does not castigate America for building a wall on its Mexican border 10 times as long as Israel is planning, nor indeed numerous other countries who have built walls for the same reasons. If Britain had not been an island, it, too, would have built walls long ago.

ALAN HALIBARD BET SHEMESH, ISRAEL

I do not ‘battle’ with my cancer

I was most distressed to read of Kate McGarrigle dying. She was a great talent. I was even more distressed though, that Andy Gill’s article (20 January) was sub-headed that she “has lost her fight with cancer”.

She did not lose the fight, any more than I won it because I’m still alive. I’m lucky, and grateful to medics, but I really can’t say that I won anything.

How does being unlucky enough to get a cancer diagnosis automatically turn you into someone brave or battling? I do all I can to look after myself, but if Iwere to get a recurrence, or to be living with a terminal diagnosis, I would really prefer not to be spoken of as someone who is fighting to beat her cancer.

This makes it sound as if we can do something about our cancers. Worse, it makes dying into a personal failure.

Yes those of us who have a diagnosis focus on getting and staying well, but it is not often in our gift to “win”. It is certainly not our fault if we “lose”.

JUDY BENSON MANCHESTER

Class in the UK: the Nazi view

Terry Pugh (Letters, 22 January) comments that “for a working- class person to become an MP he/she must convert to middle- class behaviour”.

Prior to Operation Sea Lion, the planned German invasion of England, SS General Walter Schellenberg prepared a small handbook for the invading troops and accompanying political and administrative units, describing the most important institutions of Great Britain.

Under the heading of “Composition of British Government” he stated: “The Labour Party will never achieve a revolutionary change because its leaders have, like their Conservative opponents, mainly attended feudal public schools, and so are too rooted within this system. When leading Labour Party personalities really have worked their way up from the lower social ranks the system of British society usually absorbs them socially as well as ideologically.”

DR DAVID BARTLETT ILKLEY, WEST YORKSHIRE

Ian Hislop did not mock Bob Crow on Have I Got News For You for being working class (letters, 22 January) but for his far-left political views and (unfairly in my opinion) for the militancy of his union. There was class-based mockery in the other direction though: Crow mocked Hislop for being middle- class, “posh” and Cambridge- educated (though Hislop had to correct him on the last, as he went to Oxford).

LAURIE MARKS CAMBRIDGE

Cruelty to animals

As noted by the Children’s Safety Board (report, 19 January), the brothers aged 10 and 11 who abused and tortured two boys aged nine and 11 in a quarry in South Yorkshire last April had previously been reported for killing ducks. Yet again, cruelty to animals is found to be a predictor of cruelty to people.

ANNA STANLEY CHESTER

Homophobic abuse

Johann Hari writes about homophobia in the UK (13 January). I am not gay but I am a twin. Since 2000 my brother and I,now in our midsixties, have repeatedly been singled out for abuse by homophobic gangs of boys and girls who delight in calling us “botty boys”. Behind their namecalling lurks the constant threat of violence, which is very unnerving. It seems homophobia has reached such a pitch that two men out together are automatically judged to be gay. It is time that gays and non-gays got together to combat this evil.

S D WISE BRADFORD

Haitians maligned

What a fantastic piece by Andy Kershaw about Haiti (21 January). Can you imagine London if the vast majority of its citizens were left homeless, bereaved, starving and seemingly abandoned? Just take a look at our city centres at weekend closing-time to get some idea of how “the civilised West” might react.

PAUL MORRISON DERRY, NORTHERN IRELAND

Tory grandstanding

Shaun Bailey’s moral grandstanding about what is really a problem of economics (“An entire generation left out of the economy”, 21 January) does neither him, nor the Conservatives, any credit. It is redolent of the Conservative attitude towards unemployment in the 1930s, i.e. that it was not the concern of the state. It smacks of the attitude of one Alderman Roberts, who gave the Jarrow Marchers short shrift. And it alsoexplains why the Conservatives were so unceremoniously booted out in 1945.

TIM DAVIDGE GODALMING, SURREY

Scary Spice

Just when it seemed like there couldn’t be any more bad news for the British public we have yet another bodyblow.

Now there’s going to be a Spice Girls musical (report, 21 January). I’m holding on to the forlorn hope that Vauxhall prevent the show from going ahead on the grounds that the proposed title, Viva Forever, infringes a trademark.

PAUL DUNWELL ALTON, HAMPSHIRE