Theme issue for patients

Editor—I read with interest the patient centred issue,¹ but I looked in vain for discussion of two vital and related issues—time and money. Although doctors want to do the best for their patients, they increasingly lack one of the most important resources required, namely time. Government targets cause clinics to be overbooked; managers urge their clinicians to aim for the five minute consultation; more and more non-clinical activities are introduced into the working week, reducing time spent with patients. It is not possible to have the discussions that patients want when there are 20 more people sitting outside the door and the registrar is absent after a night on. All the empowerment of patients in the world will not free up doctors to listen to the degree that they would wish, and until consideration is given to this problem there will be limited scope for the partnership that you promote and doctors and patients seek.

Related to this is the fact that patients can only get the NHS that they are prepared to fund. If they will only pay enough taxes to purchase a second hand car it is no use turning up in clinic expecting a Rolls-Royce service. In your consideration of the doctor-patient partnership I see no exploration of this direct relationship between the taxpayer and patient and the service that is available, nor any attempt to imply that the patient may bear some responsibility for a less than adequate health service.