Improving access to medical care

Editor—Cooperatives present patients with the easiest access to a doctor of any part of the NHS. We have led the way in modernising out of hours primary care, and we have been arguing for, and in many areas creating, a “whole systems approach” to access. It was therefore galling to read that “patients may have bypassed general practices and cooperatives as phone lines became overwhelmed; and accident and emergency staff often had no other options but to admit.”¹ These unfounded assertions are damaging.

The evidence set out in the report Winter Pressures on Primary Care by the Health Economics Consortium, which was commissioned by the Department of Health, showed that primary care, and cooperatives in particular, coped admirably. It is just as likely that patients would have phoned their cooperatives when faced with long delays in accident and emergency departments. Indeed, I triaged several calls made from Maidstone accident and emergency department last Boxing Day.

About 1-2% of the population contacted primary care out of hours services between 24 December 1998 and 2 January 1999. It wasn't primary care that collapsed under the strain, but a secondary service that is always working almost flat out and therefore has no spare capacity. This is because we spend less on health as a percentage of gross national product than almost any other westernised nation.