HAMISH Maclaren and Gavin Tait between them have some ideal thoughts for future NHS provision (Letters, November 8 & 10). They are not wrong. Their vision is consistent with what the NHS should aspire to – personalised care delivered safely and compassionately where possible – outwith hospital by experienced doctors, nurses and allied health professionals (AHPs). It is perhaps important to point out that they are retired from the workforce and not now experiencing first-hand the stresses and strains of demand on stretched, under-resourced and sometimes diminished primary care teams. I remember back in the late 1980s when GPs, proud of the breadth and depth of the service they were providing, invited more work to be transferred from secondary care. It has been, for many years now, but without the matched funding to deliver it other than by all working harder and longer.

One similarity worth acknowledging is that A E and general practices are alike in not being able to close the door – both require to deal quickly and safely with seriously ill patients, or those who think they may be so ill – and less urgent problems too.

In general practice, “age and infirmity”, at its most severe, now referred to as frailty, needs care and time to make sound shared decisions and plans. This applies especially to those who if not discharged timeously from hospital wards may become the unfortunate “bed-blockers”. That is one main task for GPs which we must address. Extending the GP role into community hospitals and intermediate care facilities is likely a step too far which will be resisted for the clear reason that there are not enough practitioners to deliver the service, even with highly trained nurses and community geriatricians as part of the team.

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We need the AHPs (physiotherapists and occupational therapists) along with our social work colleagues to step forward now and state what they think is possible. Their masters whether in the NHS but especially local councillors, have been quiet lately. As the research last week from Scottish Care confirmed again ("Recruitment crisis threat at care homes as shifts can cost £1,000", The Herald, November 9), attracting and keeping nurses and care staff for care homes and community services is very problematic. Improved pay and improved status are essential next steps. Who will lead that drive and are we all prepared to bear the cost?

Philip Gaskell,

General practitioner,

Woodlands Lodge, Buchanan Castle Estate, Drymen.