Dr Clare Gerada’s long read (‘In my 30 years as a GP, the profession has been horribly eroded’, 22 February) is a compelling account of the changes in general practice and of her view that the whole service has become “eroded and devalued”. She attributes this to it being “sacrificed on the altar of efficiency and expediency”. But upon whose altar, she is silent. This erosion is substantially the result of a contract in 2004 whereby GPs could opt out of out-of-hours care. Dr Peter Baddeley (24 February) refers to this contract in terms that suggest it was forced on GPs, but it was negotiated by them and was voluntary, although the majority took it up. Dr Baddeley acknowledges that his profession’s “weakness and possible complicity” were responsible for the present situation.
More may be to come. In 2020, an article entitled “GP home visits: essential patient care or disposable relic?” was published in the British Journal of General Practice, following a vote in November 2019 at the British Medical Association to “remove the anachronism of home visits from core contract work”. The then health secretary, Matt Hancock, rejected the idea – but it won’t have gone away.
The 2004 contract had another outcome: the rise in numbers attending A&E. Between 2002/03 and 2016/17 there was a 66% increase in annual A&E attendances in England, from 14.05 to 23.36m, when the population rose by only 11% and the proportion of over-65s by 13%. The Nuffield Trust recorded that annual attendances had been remarkably stable at around 14m from 1987/88 to 2002/03. It is difficult to see what else could be more responsible than the 2004 contract. That contract has a lot to answer for, and so does the medical profession. The now default GP telephone consultation is a further erosion.
Dr Stefan Slater (retired)
Edinburgh
• This article was amended on 4 March 2022. Figures had been compressed in the editing process. This has been corrected and additional information about A&E attendances in England recorded by the Nuffield Trust has been added
• Have an opinion on anything you’ve read in the Guardian today? Please email us your letter and it will be considered for publication.
