AS pharmacists may provide flu vaccinations on a private basis, there would appear to be no justification for withholding their doing so within the NHS (“Call for pharmacists to carry out vaccinations to cut pressure on GPs”, The Herald, January 10). All pharmacies have private consultation areas.

As the reason for permitting pharmacists to provide this within the NHS would appear to be to increase the uptake of vaccination among those eligible to receive it, it is necessary to first establish the reasons why the level of uptake is no greater than 41 per cent by those in that category, before going down that route.

As some of the visits to GPs and to A&E units are due to winter-related illnesses, several of which may be self-limiting, it would be helpful if the existence of the minor ailment service were given more publicity. This service is provided to all eligible patients by community pharmacists who could perhaps be more proactive in increasing awareness of the service to those identified as being eligible.

Gone are the days of cities being blanketed by smog, the result of dense smoke belching from thousands of coal fires. Although there has been a higher level of winter illness than was recorded last year, we are, thankfully, far short of suffering a flu epidemic. Heaven help us should that hit us, as the pressure on those presently working within the health service seems almost unsustainable despite their best efforts.

Malcolm Allan,

2 Tofthill Gardens, Bishopbriggs.

THERE is massive pressure on the NHS at the moment, exacerbated by the winter flu, particularly obvious for A&E departments. It is damaging morale among staff, and very misleading for the public, that the BBC and newspapers are reporting repeatedly that “just 78 per cent of patients across Scotland were seen within the target time of 4 hours”. Most are actually "seen" within a few minutes.

That figure of 78 per cent in fact refers to the 78 per cent who, within four hours from arrival, have been seen, triaged, examined, investigated (with blood tests, X-rays, CT scans and so on), treatments started and then transferred to a ward or discharged home.

What actually happens in large busy Accident and Emergency department is this:

1. All true emergencies and accidents are seen and treated immediately, without any delay.

2. All other people arriving at A&E are seen for "triage" by a nurse, usually within 10-15 minutes to decide how ill the person is, and who needs to see them (for example, surgeons, physicians, nurses).

3. For patients arriving by ambulance, the ambulance staff remain with the patient until they are seen.

4. Those who need to see a doctor are all seen within 30-40 minutes.

5. The doctor takes a history from the patient and carers, examines, assesses previous drug treatments etc, and as appropriate to each case, sends blood tests, orders X-rays and CT scans and so on to make a diagnosis.

6. Blood samples have to be transported, processed in laboratories and reported.

7. X-rays and scans have to be done and then reported by specialist staff.

8. Treatment is started to relieve symptoms and to tackle the underlying diagnosis.

9. Arrangements are made for transfer to an appropriate ward, or to return home.

As medicine has become more sophisticated, the extent of investigations has increased, and it is really extraordinary that so much is done within four hours. It should not be a serious criticism of the NHS if these steps exceed four hours in some cases, and an argument could be made to raise that target.

We call on the media not to refer to "patients not being seen for more than four hours", or "not treated for more than 4 hours". This negative language creates unwarranted anxiety amongst patients and carers, and is hurtful to dedicated hard-working NHS staff.

Mike Lean,

Professor of Human Nutrition, University of Glasgow, and Consultant Physician, Glasgow Royal Infirmary,

c/o Glasgow Royal Infirmary, Castle Street, Glasgow.

IT is disappointing that A&E waiting time targets have not been met during the festive season and I for one would be irked at undue delay when seeking medical attention.

However, it would be interesting to know how many attendances were avoidable and due to alcohol abuse, violence, over-eating, carelessness and plain stupidity when offering apologies or apportioning blame.

R Russell Smith,

96 Milton Road, Kilbirnie.