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LETTERS: Martyn C Wake None so blind BMJ 2007; 335: 628 [Full text]

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I cannot see the evidence

Hendrik J Beerstecher   (29 September 2007)

None so blind...looking for the evidence

Rowland L Cottingham   (10 October 2007)

Stoking the Demand

Felix A Udoh   (20 December 2007)

I cannot see the evidence 29 September 2007
Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA Send response to journal: Re: I cannot see the evidence	Dear Editor, As a single-hander, who closes for half a day a week I have to take issue with Dr Wake's assertions. The access in my practice and the other local single-handed practices is better than in the larger practices. During half day closure we still provide care for emergencies. Furthermore we found no relation between practice size and Accident and Emergency or MIU usage, so GP opening hours are irrelevant for inappropriate A&E use. The framework for action he refers to (http://www.healthcareforlondon.nhs.uk/framework_for_action.asp) does not offer any references to peer reviewed publications to support the notion that longer GP opening hours will reduce hospital usage. In fact one of the most prominent statements of the framework shows that the proposals go off the rails at a very early stage: 'Millions of Londoners have non life-threatening short-term illnesses for which they need prompt and convenient treatment.' The point is that if the illness is short term and self limiting, then millions of Londoners do not need any treatment at all. We should be paying attention to the taps before calling for more mops. Competing interests: I am a GMS contractor. The PCT has the responsibility to provide OOH care and for this I lose 6% income.
None so blind...looking for the evidence 10 October 2007
Rowland L Cottingham, Consultant in Emergency Medicne Brighton and Sussex Universities NHS Trust Send response to journal: Re: None so blind...looking for the evidence	Wake asserts that "over 50% of people attending accident and emergency departments would receive better care from Primary Care Practitioners." He has not referenced his claim. The evidence I have seen is a study performed by Dale and colleagues in King's College Hospital in 1995 showing that 40.9%(1)were classified as 'Primary Care' and could be seen by General Practioners (GPs). However, the GPs were 'considerably' more likely to refer Accident and Emergency (A&E) patients than A&E doctors were. I repeated the study in a semi-rural seaside town (2) and found there to be a seasonal variation; 38.7% attended with primary care problems in winter and 43.8% in the summer by the same criteria as Dale used. I am not aware of any study that has shown a higher figure than this. I would like to ask Wake to provide his evidence. 1. Dale J, Green J, Reid F, Glucksman E. Primary care in the accident and emergency department: I. Prospective identification of patients. BMJ. 1995 Aug 12;311(7002):423-6. 2. Cottingham RL. Primary care problems in patients attending a semi- rural accident and emergency unit: a prospective study. J Accid Emerg Med. 1998 May;15(3):168-9. Competing interests: I have conducted a study into Primary care attenders at an Emergency Department.
Stoking the Demand 20 December 2007
Felix A Udoh, GP Principal Green Cedars N18 1QX Send response to journal: Re: Stoking the Demand	Wake says that there is increasing pressure to increase hours,..He cites no evidence whatsoever. Survey of over 2 million commissioned by DOH showed 84% satisfaction with existing GP surgery hours but this is never mentioned by anyone in government,especially doctors paid by PCTs like Wake, who should accept the fact that they now simply function as mouthpieces for the next grand scheme dreamed up at Downing Street. This survey is solid evidence increased opening hours are not an issue with the public, despite the loaded questions fed to the public. The only clamour seems to be from DOH, PCTs who at the same time do not want to fund it. The impetus came from the top - Gordon Brown and Alan Johnson, but where's the evidence the public wants or needs this? What next? 24 hour GP Surgery services? Meanwhile CBT unavailable and 6 month waits for counselling routine. Competing interests: GP