SIR – In 2008 I analysed more than 2,000 GP telephone consultations – setting out to demonstrate the benefits of this method of care.
They averaged five minutes in length. Over half had to be followed by a face-to-face consultation, averaging 10 minutes. If, as reported, 57 per cent of patients now see their GP in person following a telephone consultation, the result is a 7 per cent increase in workload compared to seeing all patients in person.
Patients generally want to visit the surgery to consult a doctor, and telephone consultations leave neither the doctor nor the patient fully satisfied. This increases GP stress and leads to further appointment requests – yet more work for the GP.
Telephone consultation should only be used when requested by a patient.
GPs' workload can be reduced through skill mix – having people in non-medical roles working alongside them. However, a major potential source of staff has been overlooked – the huge number of people who volunteered to assist the NHS in the pandemic. Lay people can be used in health screening, to measure height and weight, and test blood pressure. Less than 7 per cent of GPs who volunteered were called on. They could provide support to practices.
Simon Fradd MRCGP
SIR – It isn't just GPs who have cut back on face-to-face consultations. The last time I saw my oncologist was 10 days before I completed my radiotherapy for neck cancer. In the six months since, I have had monthly telephone consultations, mostly with a doctor but occasionally with a nurse.
After a couple of chats, the report to my GP stated: "I saw Mr Simpson in clinic today." How can they justify this?
Roger T Simpson
SIR – In 1993 I joined a practice of two GPs delivering all primary care to 3,600 patients with the help of two receptionists. An average patient came four times a year. Now, two GPs lead a team of 30 extensively trained staff caring for 4,800 patients. An average patient visits nine times a year.
We no longer refer everyone with blood pressure problems, asthma, diabetes, chronic kidney disease, high cholesterol, and so on. We diagnose and manage these in house.
Seeing that the country could not fill all the gaps by training more GPs, the Government introduced clinical pharmacists, primary care mental health practitioners, first-contact physiotherapists, even befrienders, and many more ancillary roles to help GPs. This is called skill mix. These professionals assess, investigate, prescribe, refer and treat within their own specialties better than I can.
Politicians therefore need to stop telling patients to demand face-to-face appointments with a doctor and advise them to engage with receptionists and be signposted to the right member of the extended primary care team.
Dr Ken Leeper
Royal Marines reform
SIR – All of us in the Royal Navy community were shocked and saddened by the untimely death of Major General Matt Holmes ( report, October 13 ), particularly those of us who have served closely alongside the Royal Marines in peace and war.
In light of the circumstances of his death, it was a shame that reports included allusions to a supposed rift within the naval service earlier this year over the introduction of reforms across Navy Command, which will make the Navy capable of competing confidently and effectively in the 21st century.
These reforms included, in the wake of their distinguished service on land in Afghanistan and Iraq, the Royal Marines, who, in line with the Government's recent Integrated Review, needed to revive and expand their specialist commando role as the primary weapon and assault system of our amphibious and littoral combat ships. Matt was a committed advocate for this Future Commando Force initiative, which is enthusiastically championed by the current generation of Royal Marines.
It is therefore to be regretted that some retired senior Royal Marines officers, for personal or regressive reasons, sought to exploit the occasion of Matt Holmes's death to turn the operational clock back and provoke a needless and spurious dispute within the Royal Navy.
Rear Admiral Dr Chris Parry
Thank-you rail mail
SIR – Some time ago, I mislaid my camera at Canterbury West railway station.
I was returning to Maidstone and had to change at Ashford. I mentioned my loss to a member of the station staff ( Letters, October 14 ). The same day I had a call to say the camera would be waiting for me to collect at Maidstone station.
I wrote a thank-you letter to Ashford station and received a reply thanking me for my letter, which was now on the staff notice board as they received so few of these.
SIR – At the end of a railway journey, my maternal grandmother would alight from the carriage and go to the front of the train to thank the steam-engine driver personally.
SIR – On October 9 Leicester diocese decided to close down its traditional parishes. This represents a backward step in the Church of England's bid to save money.
We are told that minsters will be created. These will be nebulous bodies with no specific geographical location and no vicars attached to what were the original parish communities. Parishes will see it as losing their vicar, the vicarage, their local Christian community, and, ultimately, their church building.
Meanwhile, diocesan bureaucracy expands at a giddy pace. Each minster – and there will be about 40 – will have a resident "operations director", presumably earning around £40,000.
In response, the parishes are saying: we do not need two bishops and two archdeacons. We do not need "mission enablers" and directors of diversity and inclusivity. We do not need directors of giving and human resource management, because we in the parishes have been coming to the conclusion that it would be cheaper to recruit and pay vicars ourselves.
We certainly do not need another 40 operations directors.
Many bishops have gone on record to say that the only way forward is to increase income, not cut central bureaucracy costs. But upwards of 40 per cent of their income comes from parish giving, in the form of the "parish share", and they are now planning to destroy the parishes. How is this going to increase income?
It almost seems that Christians in this country are faced with a basic dilemma – are we supposed to worship God, or bureaucracy? It appears that the people running the Leicester diocese have already made this decision for us.
Professor R G Faulkner
SIR – You report ( October 14 ) that Mark Serwotka of the Public and Commercial Services Union wants a deal at the DVLA with "appropriate reward and recognition for staff working through the pandemic".
I'm sure many workers who were on furlough through no fault of their own would have preferred to be on full pay, working from home.
DVLA workers who are the cause of such damaging delays for HGV licences and now support this strike should hang their heads in shame.
SIR – My son, an airline pilot, was made redundant and decided to apply for an HGV licence to become a lorry driver. His course is to start some time in December at a cost of approximately £2,000. He will have to pay a further £1,000 for an articulated endorsement. It will apparently take a further five months for the licence to be granted by the DVLA.
Such expense and delay will undoubtedly reduce recruitment for HGV driving jobs. Surely someone in authority could address this problem.
The Queen in peril
SIR – Will one of the Queen's advisers let her know that a walking stick must not be used while carrying a handbag in one hand and a bouquet of flowers in the other. It is a trip to disaster.
I am 82 and know the help that walking sticks can give, but also their danger if one is carrying other items.
The Queen's lady-in-waiting should carry Her Majesty's handbag, and then any flowers given to the Queen.
An understudy who was a star waiting to shine
SIR – I do not understand fans demanding their money back after watching an understudy in the lead role of a performance of Cinderella, Andrew Lloyd-Webber's new musical (report, October 11 ).
I well remember going to see the musical theatre production of Billy Liar in 1961, when an understudy took over from Albert Finney, who was the star. It was a young actor named Tom Courtenay, and we had no idea what to expect.
Never underestimate the talent of understudies. What a gift! What a performance! The whole audience knew it was a very special evening.
It doesn't happen every time, but you never know when that magic will light up the stage.
Lynyrd Skynyrd's lyrics were opposed to racism
SIR – The report on politically incorrect lyrics ( October 14 ) refers to Sweet Home Alabama by Lynyrd Skynyrd, in which George Wallace – a racist former governor of Alabama – is apparently celebrated.
The lyrics are, however, ironic – hence the line: "In Birmingham they love the governor, boo-hoo-hoo." A little later the song asks, "Does your conscience bother you?"
The band may or may not have been good citizens, but here they were standing against racism and pointing out that not all southern American men are racists. In fact these days, the band has an American Indian member.
SIR – The lyrics of the Rolling Stones' song Brown Sugar do not praise slavery, but they do celebrate the sexuality of black women – which has always appealed to Mick Jagger.
The narrative changes from recording a deeply oppressive situation in the third person, to the first person, when he sings: "I'm no schoolboy but I know what I like."
If the lyrics offend then change them, as the band did with their song Let's Spend the Night Together which, for American audiences, were changed to: "Let's spend some time together."
Musically, Brown Sugar is arguably the Rolling Stones' most exciting track. When played, it is guaranteed to get people on to the dance floor, and that is because of the music, not the lyrics.
It's certainly my favourite Stones' track, both to listen to and to play. It is also my wife's favourite – and she is a black Jamaican.
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