A LACK of direct access to electronic medical records is, according to the Royal Pharmaceutical Society, an “urgent patient safety concern” (“Pharmacists in warning over poor access to patient records, The Herald, October 28). “That health professionals need all the information available about patients,” comments the associated Herald leader article, “is surely obvious” (“Pharmacists must have access to health records”, The Herald, October 28).

In the reality of medical practice, access to the patient’s medical record, be it paper or electronic, is of very limited value. This is as true in the emergency department resuscitation room as it is in the GP surgery. All medicine is acute. Think about it. All these test results from last month or last year are out of date. Repeat the tests now and the results will be different. All that correspondence between GPs and consultants comprise diagnostic formulations that might have been inaccurate in the first place and in any case no longer pertain. Any piece of information that is truly vital can be worn on a Medicalert bracelet. When a GP is faced with a three-volume record the size of War & Peace, whether it belong to a patient with multiple pathologies or to one of “the worried well”, the best thing he can do is close the file, empty his mind of all preconceptions, and say: “Tell me what it is that is troubling you to-day.” Don’t look at the computer screen; look at the patient. The best consultations occur when the computers have crashed.

The medical profession has to wake up to the fact that information technology is all about power. The more elaborate and interconnected the systems become, the more the model of health care will be dictated by people who don’t know anything about medicine. Much of the truly significant communication between doctor and patient is never recorded. But even so, open access to the medical record by all health and social care workers will destroy confidentiality, trust, the sanctity of the medical consultation and in the end, general practice itself.

Dr Hamish Maclaren,

1 Grays Loan, Thornhill, Stirling.

"IT is still not clear how moving care into the community will be funded and what future funding levels will be required.

A clear and long term framework is needed". Thus states Auditor General Caroline Gardner in her Key Messages in the annual review of the NHS in Scotland published last week (Watchdog reveals the sorry state of NHS in Scotland", The Herald, October 26, and Letters, October 27). Of course the Health Secretary will cite a new GP contract for April and the maturing of integration joint boards (IJBs) as vehicles for change and focus on the assessment and care required to support older people in or nearer their homes.

In recent years GPs and nursing colleagues have developed anticipatory care plans with those with chronic illnesses. Addressing Do Not Attempt Resuscitation decisions should form part of that as well as the contribution of realistic medicine – how much treatment and where does the individual want that delivered are important elements.

The main uncertainty is around family and patient confidence in community care, the capacity of IJBs to deliver that and the costs involved. It seems quite unlikely that IJBs will manage to release money from the parts of the hospital services budget they hold – and actually care at home isn't always cheaper.

"Brand confidence" is yet to be won, so that when patients feel uncertain, are anxious and in pain effective medical, nursing and care assistance can be brought to their bedside rapidly.

GPs as "expert community generalists" will also need to lead well the expanded primary care teams so that common purpose and excellent communication compensate for the loss of continuity of care which they and their patients have valued so much but is now diluted.

IJBs vary in their maturity and as Ms Gardner points out we all lack information about primary and community care on which to base decisions. They and we GPs carry a heavy responsibility, but cannot guarantee success and the social care contribution to the project is likely to be key.

It would be helpful – but as always, unlikely – if politicians came together to formulate longer-term plans for this crucial area of health and social care forming nigh on 50 per cent of the government budget.

Uncertainty, lack of information, difficult decisions, good communication, a need for leadership – daily meat and drink for most GPs, but can politicians rise to that?

Philip Gaskell,

General practitioner,

Woodlands Lodge,

Buchanan Castle Estate,

Drymen.