THE new GP contract, which started this week, serves several purposes, but despite statements by the First Minister and Cabinet Secretary for Health in the Scottish Parliament in 2015, it does not address the issue of unmet need in deprived areas. As the Deloitte report, which informed the new allocation formula, acknowledged, a formula based on GP workload takes no account of work which cannot be done and of needs which cannot be met because there is a lack of time to address them.

A research study comparing GP consultations in relatively affluent and deprived areas in the west of Scotland, which was published recently in the Annals of Family Medicine, showed that while patients with complex problems in affluent areas had 25 per cent more time with their GP, similar patients in deprived areas got no more time than average. It is not difficult to predict the consequences. Unmet need results in uncoordinated care. As problems are addressed less well, complications are not avoided and patients present to emergency services. This chain of events needs to be addressed at source.

The most deprived third of Scottish parliamentary constituencies are all represented by SNP MPs, including the First Minister and Cabinet Secretary. They could hardly have been less effective in representing this interest of their constituents.

Compared with the funding formula of the previous GP contract, there is an across the board increase of four per cent in funding, which is no different in the most affluent and deprived areas. Affluent practices with the most elderly patients continue to receive the highest GP funding per patient per annum. Is health care primarily a reward for longevity or is it also an instrument of social justice addressing differences in longevity?

The Scottish Government’s only policy initiative to address the additional needs of deprived areas was its manifesto commitment to introduce 250 new link workers, targeting deprived areas. But the funding for this appears to have been hijacked, so that link workers will be distributed throughout Scotland and not where they are needed most.

The GP contract is essentially a method of paying doctors and is discredited as a way of resourcing extra clinical capacity in deprived areas. The Government needs to find other ways of addressing and prioritising this problem. It already has small examples in the Govan SHIP (social and health integrated partnership) and GP Pioneer schemes of how putting young GPs into deprived practices improves morale, increases clinical capacity, lets experienced GPs address the needs of complex patients, attracts young doctors and aids GP retention.

Delegating responsibility to the new integrated joint boards of health and social care partnerships is an unproven solution. The NHS in Glasgow has yet to recognise in any report or policy statement that underfunding of general practice in the city is a problem. Other interests take priority. The city’s imminent Primary Care Improvement Plan will be a litmus test of political resolve.

Graham Watt,

Emeritus Professor, General Practice and Primary Care, University of Glasgow.

WE should rightly celebrate the birthday of the NHS ("The NHS needs a dose of reality for its 70th birthday", Herald editorial, April 2). The National Health Service was formed in 1947 and has been growing ever since. The SNP approach is to throw more money at the problem and hope that it goes away. NHS Scotland needs some radical reform.

NHS Scotland does have the funding it needs. We need to make better use of the money available.

Bed blocking is a major problem. Patients who are well enough to be sent home occupy hospital beds costing £235 per day. Hotel beds are available for £30 to £70 a day. Even with a care package, hotel costs would be £60 to £100; a considerable saving. The true cost of bed blocking will be much greater since it affects the efficiency of the entire hospital.

The SNP Government is asset-stripping Scotland. Care homes were the major industry in Helensburgh when my father was alive. In 2008 there were 12 care homes in the town. Today, there are three. Lack of adequate government support has decimated the sector. No care home beds adds to the bed blocking problem..

The GP out-of-hours service should be eliminated. This duplicates other services such as ambulances and paramedics. The resources should be used to extend GP surgery hours which are currently 14.5 patient contact hours per week at my local GP surgery.

One-third of the NHS budget is spent on administration, on paper pushers who have no patient contact. Fire the paper pushers, double the salaries of front line nurses. Solve the problems of NHS Scotland today.

John Black,

The Scottish Jacobite Party, 6 Woodhollow House, Helensburgh.

WITH the NHS in dire straits we need to consider prioritising patents. Our ageing, growing, over-indulging population means hard choices and rationing.

Do we really consider those seeking boob jobs, tucks, gender or fertility procedures as important as a child or mother seeking treatment for cancer? Should smokers, addicts, drunks, the obese and those who miss appointments clog up the system? In fact, should "deserving" geriatrics like me block beds or demand expensive procedures?

If our health service is to be sustained long-term, more personal responsibility is as essential as more funding. The NHS needs to demonstrate to patients that while it is an open, generous and benevolent system, their actions do have consequences and heroic efforts to extend geriatric lives by a few days is a luxury it simply cannot afford.

Rev Dr John Cameron,

10 Howard Place, St Andrews.

ONE name missing from the roll of honour of those who have contributed to advances in the field of medicine in Scotland ("Celebrating a revolution in Scotland's healthcare", The Herald, April 2) is that of Professor Sir James Black, physician and pharmacologist.

His discovery of the first beta blocker drug, propranolol, was a major advance in the treatment of hypertension and which was therefore a true life-saver. His continued research then resulted in the production of the anti ulcer drug, cimetidine, which considerably reduced the need for surgery.

Prof Black was awarded the Nobel prize for medicine in 1988. His name deserves to be as well recognised in Scotland and further afield as that of Sir Alexander Fleming.

Malcolm Allan,

2 Tofthill Gardens, Bishopbriggs.