TORY health spokesman Miles Briggs says: “It’s no wonder Scotland is in the grip of a general practice crisis when the SNP Government fails so miserably to attract doctors to the job” (“GP drive only recruits 18”, The Herald, November 7). But Mr Briggs must be aware that the GP crisis is even worse in England. Is he going to blame the Conservative Government?

The hard truth is that we doctors must shoulder a lot of the blame for the situation that has arisen. We committed a fatal error around 2004-5 when most of us handed over responsibility for out-of-hours care to trusts or health boards. The opportunity to stop being on call, to shut the surgery door at 6pm and not look back, looked like a priceless gift but turned out to be a poisoned chalice. With power comes responsibility. If you abrogate the responsibility, you lose the power. Thereafter, it hardly mattered how well a GP was paid or how much free time he was given. He would be at somebody else’s beck and call, powerless and miserable. GPs shortly became slaves to the Quality Outcomes Framework (QOF) issuing its absurd directives through pop-up menus on the computer screen.

But the QOF has been abolished, a new GP contract is due next year, and the profession has an opportunity to tell politicians what is required. I’m retired now (I was going to say old and burnt-out), but for what it’s worth, here in 10 points is my model of care that my ex-colleagues might place before both politicians and aspiring GP trainees:

Practices should take back out-of-hours care.

Each (full-time equivalent) GP should look after a “flock” of 1,000 souls.

Run 15-minute appointments.

Attach an in-patient unit to the GP health centre, or group of health centres, run by GPs and practice nurses.

One use of the in-patient unit, among others, would be the care of frail elderly patients whose primary need may be for short-term nursing care.

Have one non-clinical working day per week “off the floor” for education, research, administration, and special interests.

Be on site when on call, at the in-patient unit, 6pm to 8am.

Schedule your day “off the floor” to follow your night on call.

Don’t be on call more often than three times a month.

Practise pure clinical medicine and don’t allow anybody who doesn’t know anything about medicine tell you how to do it.

Dr Hamish Maclaren,

1 Grays Loan, Thornhill, Stirling.

THE crisis in low applications for GP training is mirrored in a similar crisis in hospital specialties. However the situation has been developing for years as a consequence of the Scottish medical schools, primarily Glasgow, Edinburgh and St Andrews, favouring intakes of English and overseas students. Overseas students are commercially more attractive, and Edinburgh and St Andrews places are sought after by the mainly-English public school students who fail to access Oxbridge.

Recently it has been acknowledged that for the first time the proportion of Scottish domicile students at Scottish medical schools has fallen below 50 per cent. As medical graduates tend to train and eventually practise near home and family Scotland may be losing the graduate output of two medical schools annually to firth of the Border. No wonder there are multiple vacancies on Scottish post-graduate training schemes.

As medical school staff tend to select students from schools and backgrounds with which they are familiar the problem for Scottish state students will only increase.

This bias was highlighted many years ago in the Scottish media but the problem has only worsened.

There are some small efforts made by medical schools to reach out to Scottish state pupils but they do not go far enough, while private schools maintain a disproportionate hold on medical school intake. Such graduates will work in cities to the exclusion of county towns and rural areas.

There must be an increased drive to recruit medical students from all over Scotland, to the exclusion of non-Scots, particularly from county schools. Only then will more graduates see the value of a career in the widespread National Health Service in Scotland, in communities with which they are familiar and comfortable.

Selection for medical school is only part of the problem. Uncertainty about independence, the media image of a failing NHS, oppressive appraisal and supervision, forthcoming higher taxes and a poorer pension after working until age 70 only reinforce the unattractive nature of a medical career in Scotland.

Gavin R Tait FRCSEd,

37 Fairlie,

East Kilbride.