Letter: Two-tier NHS that we should all fear

YOUR article on Alex Hall and his decision to become a GP fund- holder against his better judgement (' 'Why I must bow to a system I hate' - GP', 11 July) may have left some readers confused as to how a change in Dr Hall's status could have benefited his patients. The elderly ladies mentioned in the article were presumably admitted as emergencies, but it is debateable whether their inappropriate discharge from hospital would have occurred had he been a fund-holder. Maybe the facilities to help these ladies cope at home were just over-stretched.

The man with bowel cancer received his surgery relatively quickly thanks to Dr Hall's persistence, but there is little doubt that he might have been treated even more quickly if Dr Hall had financial muscles to flex. Therein lies the two-tier system: money following patients has been stood on its head so that patients now follow money.

The article should have left no one in any doubt that the concept of 'too many hospital beds in London' is fictitious. The difficulty faced by Dr Hall in getting rapid treatment for patients with serious diseases, and in having to cope with the consequences of the elderly and frail being discharged inappropriately, should surprise no one except those gullible enough to believe the ritual chants from the Department of Health that London is over- provided.

Dr Hall's patients represent the tiny tip of a giant iceberg. GPs nationwide know that patients might spend hours in accident and emergency departments while staff search frantically for beds. Patients may languish in beds in district hospitals waiting for a bed to become available in a regional centre for specialist treatment for heart disease, for example. Like stacked-up aircraft, they wait in increasing numbers while the runways are continually full. Virginia Bottomley's assertion that primary care will benefit from the savings produced by the closure of some London hospitals is fatally flawed and destined to be discredited in practice.

GPs like Dr Hall who are given better facilities and more time to see patients will rightly expect more from their hospitals. Good general practice will increase demand for hospital services. One wonders when Mrs Bottomley will face up to the truth - robbing Peter to pay Paul serves no one.

Duncan S Dymond

Consultant Cardiologist

St Bartholomew's Hospital

London EC1