Do patients want first class or economy services?

EDITOR—Rayner's wish list in her personal view about a patient's eye view of quality in the NHS contains nothing that I would not want for myself as a patient, but her article fails to address issues of resourcing, except where she mentions the “sizeable fees collected” by alternative practitioners.1

In a crowded surgery recently I spent half an hour with an anxious patient exploring the patient's concerns about forthcoming hospital treatment. I met that patient's needs and wants, and as a result my surgery ran late and other patients in the waiting room grumbled. This sort of thing happens all the time and cannot be solved by bringing the patient back at a quiet time because there aren't any such times. In any case, that would hardly satisfy Rayner, who wants us to be responsive to our patients' anxieties at the time when they are expressed.

We cannot please everyone all the time or guarantee always to satisfy such a comprehensive wish list within existing time pressures and limited resources. British general practitioners know how to provide a quality service, and usually do, but are compelled to provide a high volume economy service in which there is no limit on demand. To make it through the day we sometimes have to compromise on the niceties of life, unlike the alternative practitioners, in whose case the money comes with the patient.

I recently paid around £1000 to fly economy class to New Zealand. It was OK but cramped, and I didn't like the films. A first class ticket would have been much more agreeable, and, like Rayner's vision of the NHS, would have cost about twice as much.

If the Patients Association wishes to make a useful contribution to the debate on quality I suggest that it gets together with …