The issue here is the variable quality of commissioning of care by PCTs which have been responsible for organising out-of-hours care since 2004. Services are fragmented and inconsistent, risking diagnostic delay. There is a need for a national programme to improve standards. This will include better information for patients, more joined-up services and better training and enforcement of quality standards.

The report also shows that where PCTs have forged good relationships with GPs and involved them in planning, services are conspicuously better. To provide comprehensive 24-hour cover for urgent care will require the combination of several providers and professionals but GPs cannot be replaced.

MAYUR LAKHANI
Royal College of General Practitioners
London SW7

Sir, Jamie Whyte suggests that healthcare should be privatised because “Jack smokes, drinks and overeats. Jill does not. Jack’s behaviour means he consumes more healthcare than Jill. It would be unfair if healthcare cost Jack and Jill the same” (“You want fairness, you pay up”, May 5). What happens when Jill gets breast cancer? Is it fair that she should die if she can’t afford the radiotherapy?

There is already a privatised healthcare system — it has had a perfectly fair test in the richest country in the world. Americans spend 16 per cent of their GDP on healthcare — twice what Britons spend. Yet 45 million Americans have no health insurance at all, whereas the NHS covers everybody. The inefficiency is shown by the astronomical cost of management and administration in the US — 30 per cent of total health spending. Perhaps this explain why Jack and Jill consistently say that the NHS is their most valued institution.

ALEX NUNNS
Keep Our NHS Public
Bishop’s Stortford, Herts

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