AS working GPs in Scotland’s “Deep End” practices who are also representatives of the Deep End Steering Group, we are both strong believers in the founding principles of the NHS and in healthcare resource being allocated proportionate to the needs, and not the demands, of local populations. This is critical to addressing health inequality.

We have campaigned for many years for the need to adequately invest in general practice to achieve better population heath. The mechanisms by which GPs receive funding and deliver services are complex and vary across Scotland, influenced by factors such as local geography and availability of staff. This explains much of the variation in income across practices but, nevertheless, we were concerned to read about the disproportionately high income received by a tiny minority of Scotland’s GPs (“Cash to boost the health of poorest goes to GP salaries”, The Herald, February 9). We believe this may impact on the reputation of the whole profession.

Under the existing funding formula, Deep End GPs do not get extra money and under the new formula they do not get much more.

Continuing to campaign for adequate resourcing of the independent contractor model requires the trust of the Scottish Government and the public. To enable this we would support greater transparency around the allocation and utilisation of resource, including transparency of GP incomes and we agree with the recommendation from Reform Scotland that GP accounts should be published. We welcome the new contract guarantee of a minimum income for all GPs and we propose there should be an open debate between the profession and the Scottish Government as to what might constitute a reasonable maximum income.

Dr Helene Irvine’s research shows that individual GP earnings are only one aspect of a range of valuable insights that help us to understand the effects of sustained under-resourcing of general practice on the wider healthcare system. We would welcome the publication of these findings to more fully inform ongoing discussions about how we ensure a sustainable NHS in Scotland and meaningfully tackle persisting health inequalities.

Dr David Blane GP, Glasgow,

Dr Margaret Craig GP, Glasgow,

Dr Lynsay Crawford GP, Glasgow,

Dr Maria Duffy GP, Glasgow,

Dr John Montgomery GP, Glasgow,

Dr Catriona Morton GP, Edinburgh,)

Dr Anne Mullin GP, Glasgow and chairwoman, GPs at the Deep End Steering Group,

Dr Jim O ’Neil GP, Glasgow,

Dr Petra Sambale GP, Glasgow,

c/o Govan Health Centre,

5 Drumoyne Road, Glasgow.

THE “extra money” given to a deprived practice would not account for, nor does it need to account for, the income. If there is a GP vacancy that cannot be filled, for example, that income is likely to be spread amongst partners.

If there is more than one vacancy, the numbers become dramatic. The practice still needs to provide the requisite number of appointments and care targets so those doctors really do have to do the work of the vacant posts, which I doubt is by choice. Partners and locums aren’t out there. Which practices do you suppose struggle most to recruit, I wonder? It should also be said that NHS income is not necessarily practice-based income. I suspect the quoted income is a complete outlier and the others differ by a more modest margin, not least because it would be impossible otherwise when primary care only accounts for 7.4 per cent of the NHS budget.

Denis Clifford,

25 Ladeside Drive, Kilsyth.

RICHARD Holloway, the former Episcopalian Bishop of Edinburgh, is correct to draw attention to the quality-of-life issue in our society (“Holloway: Old people kept alive long after any pleasure has gone”, The Herald, February 12)

We are each responsible for our health and welfare and should be fully informed when a medical procedure takes place but this is not always the case.The doctor’s ethics are to keep the patient alive at all costs. Quality of life is seldom discussed.

We need an open debate on this issue and the related matter of death with dignity. The last bill on assisted suicide in the Scottish Parliament was badly framed and was rejected by the Parliament. I lived in Portland, Oregon when the Oregon death with dignity bill was passed by the state legislature in 1998. My best friend used the act to take his life in 2006. Since then, an equivalent measure has been passed by Washington State.

On Saturday, I had to attend the Vale of Leven Hospital with an inflamed varicose vein in my right leg. I saw my GP in Helensburgh on Friday afternoon and was referred for overnight antibiotics infusion. When I got to the hospital, there was no record of my existence. I got a taxi home. On Saturday morning, I visited my local pharmacy to see if the pharmacist could prescribe oral antibiotics. The pharmacist is legally prevented from prescribing antibiotics because of the overuse problem and could not access my medical records.

At 12.20 I was in the medical assessment unit at the Vale of Leven Hospital. I was examined by two more doctors before I received any treatment. My cost to the NHS was three times higher than necessary. A nurse drew a blood sample. As this was a weekend, the local blood lab was closed and samples have to be delivered by taxi to the Royal Alexandra Hospital in Paisley for analysis. This is lunacy. A skilled lab technician could do these tests in Alexandria at considerably less cost than paying a fleet of taxis to take an additional three quarters an hour delivering blood samples to Paisley.

The blood analysis results eventually arrived at 4.09pm just as I was signing the waiver forms to discharge myself from hospital I made the target of four hours in the unit by eleven minutes.There are gross inefficiencies in NHS Scotland. Addressing these would save the taxpayer money

John Black,

Former Professor of Biochemistry and Medical Genetics,

6 Woodhollow House, Helensburgh.

I CAN see where Richard Holloway is coming from when he suggests that the NHS may sometimes keep too many people alive long after any pleasure or meaning has gone from their lives and why the realistic medicine movement debates how to balance quantity and quality of life.

But as no spring chicken I hope I will be allowed some say in the matter before the decision to give up my ghost is made.

R Russell Smith,

96 Milton Road,