To fix primary care, GPs will need a change of attitude

But in order for this to work, primary care doctors would have to take on some of the attitudes, and work practices, of hospital doctors. Crucially, general practices must take back responsibility for round-the-clock, 24/7 patient care. A community of 10,000 people would have at its heart a health centre, with 10 doctors, as well as nursing staff, and various other professions allied to medicine, for example physiotherapy, clinical psychology, and so on. With a per capita list of 1,000, a doctor would be unlikely to see more than 100 patients per week. A FTE doctor might see, for example, 25 patients on each of four days, be on-call one night per week, and have a non-clinical day following the night on call, for pursuit of special interests, research, administration, or if necessary to catch up on sleep. Such a workload would be sustainable in the long term.

The health centre would have an in-patient unit. Actually it would have three quite small in-patient units, comprising a short-stay ward, a hospice, and a care home. The short-stay ward would be there primarily for patients, many of them frail and elderly, whose principal need would be nursing care. The presence of a hospice would ensure the integration of a palliative care service, currently charitable, "Cinderella", and under threat as never before, firmly within the NHS. The attachment of a care home to the practice would form a basis (and fulfil an aspiration that has not progressed for 25 years) of a National Care Service.

We should run a pilot.

Dr Hamish Maclaren, Stirling.

Read more letters

• Now can we put to bed the myth that Scotland is better than England?
• Lowering the speed limit won't change anything

Scotland's NHS is better

CONTRARY to Jill Stephenson’s assertions (Letters, November 29), the English NHS performance is still worse than the Scottish performance, and will be lagging until such time that it might overtake Scotland. Currently, in England, three times as many wait more than 12 hours in A&E departments and for the A&E four-hour treatment waiting time, NHS Scotland is 11.7% faster. Scotland’s cancer waiting times remain dramatically better than England’s, particularly for breast, lung and liver cancers, thus saving thousands of lives. If you have a chronic non-life-threatening condition, like arthritis, painful though that may be, a resource-strapped health service cannot always be expected to treat that in the shorter term.

The IFS report did not include comparisons with the much worse-performing NHS in Labour-run Wales and I am sure that has nothing to do with the fact that the last couple of IFS reports on Scotland were funded and questions framed by the Economic and Social Research Council, which is entirely funded by the UK Government.

Mary Thomas, Edinburgh.

• JILL Stephenson makes a very basic statistical mistake of assuming, that because the Scottish NHS is recovering less quickly from Covid-19, then it cannot be better in comparison with NHS delivery in other parts of the UK. That is a misreading of statistics and you would need other data to analyse it properly.

Also the noun versions of the verb to separate are "separation", "separator" and "separationist".

Iain Cope, Glasgow.

SNP move too little too late

LIFE is cruel. No sooner has Anas Sarwar won your Politician of the Year award when the SNP rains on his parade and steals his thunder by announcing the return of the pensioners' winter fuel payment ("All Scottish pensioner households to get £100 winter payout", heraldscotland, November 29). Of course it is not quite all it seems as many will get £100 rather than £200 but this will be conveniently glossed over by the SNP. All of this in an effort to garner support for the 2026 Holyrood election.

After all this time in office by the SNP Scots are too canny to fall for this type of "inducement". £100 is not going to eliminate in voters' minds all the failures and money wasted presided over by the SNP. Nice try, though.

Dr Gerald Edwards, Glasgow.

• MY neighbours have the same size of house as me. In April, they will, due to increases in pension linked to their date of birth (born three years after me) each be getting £50 a week more than me. Now they will get £200 as a winter fuel allowance while I will only get £100. Has the SNP not realised that there is a monetary difference if based on one or two people living in the house but the same need for the heating?

Elizabeth Hands, Armadale.

Give us powers over broadcasting

I NOTE that Sunset Song, the classic Lewis Grassic Gibbon novel, has been removed from the Scottish set text list for Higher English in response to low uptake. The Cheviot, The Stag and The Black, Black Oil has also been removed and Robert Burns is no longer a separate author on the Higher English reading list.

This is is further evidence of the anglicisation of Scottish language and culture and the dumbing down of works considered too difficult or unfamiliar.

Part of this is due to the fact that broadcasting is reserved to Westminster and BBC Scotland pays lip service to Scottish drama, arts and music on TV. The “Scottish qualifying” quota of television production is primarily coverage of the snooker and bowls by companies with a token Scottish branch office. STV is worse, and pays more to screen England football internationals than for any Scottish cultural or sporting content.

As GS Barrow said, in his inaugural lecture as Professor of Scottish History in the University of Edinburgh in 1979: "The failure of Scotland to establish its own organisation for public service broadcasting was the greatest cultural disaster which Scotland suffered in the 20th century."

It is perfectly possible for the current UK Government to allow the Scottish Parliament to have powers over broadcasting, but there is reluctance from Westminster to allow it to happen. This could be some actual change from Labour prior to renewing the BBC’s Royal Charter on December 31, 2027.

Fraser Grant, Edinburgh.

Should powers over broadcasting be devolved? (Image: Jeff J Mitchell) A vision for road safety

TO try to reduce road accidents, politicians tinker with speed limits (“Speed limits may be cut for motorists but upped for lorries”, The Herald, November 29). Currently their wish to reduce them for cars on open roads may simply increase convoying and consequential driver frustration. Imposing 20 mph and even 10 mph on local roads is all very worthy but to comply with these limits drivers need to monitor their speed continuously, which may in itself be a hazardous distraction.

Speedometers are located on dashboards beneath the windscreen, so drivers have to look down to check their speed. They thus have to risk taking their eyes off the road for however long that takes, unless their vehicle is one of the few which has a heads-up facility. That facility displays their speed at eye level on the windscreen with obvious safety benefits. Should that facility not be made a mandatory fixture on all new vehicles in the future?

Alan Fitzpatrick, Dunlop.

• THE Scottish Government proposes to introduce a 50 mph speed limit for single-carriageway rural roads. If enforcement is anything like it is for 20 mph speed limits, red lights and parking on the pavement, such change should cause little practical inconvenience for the motoring public.

Scott Simpson, Bearsden.

Answer is in the post

EXPERIENCE of the courier industry tells me that the sale of Royal Mail ("Royal Mail closes in on takeover deal after ‘concessions agreed’ – reports", heraldscotland, November 28) to a foreign concern could create an opportunity for our many excellent private UK courier companies, who at present cannot deliver letters because of protective legislation that prevents private firms from delivering any item for less than £2. This legislation could be scrapped.

A courier could then spend a profitable day delivering letters for £1 an item, as each address might take two or more items, and deliveries would be house to house by street, and not miles apart, as with parcels, so all at low cost. City addresses would be an absolute courier bonanza.

It is indeed an ill wind that does not blow some good.

Malcolm Parkin, Kinross.

Double standards

I HAVE some sympathy for Greg Wallace as he steps back from the day job while allegations of his making inappropriate sexual jokes are investigated ("Rod blast as Wallace steps aside, The Herald, November 29).

Had Wallace been an Anglican archbishop investigated over several years for failing to report the activities of a serial child sex abuser, he could have carried on regardless as a member of the House of Lords, buried a queen and crowned a king.

Alistair McBay, Perth.

Crack down on scammers

SCAM Interceptors, currently being screened daily on BBC, is a programme aimed at alerting the public, particularly the elderly, to unscrupulous fraudsters. Whilst an informative narrative is provided by presenters Rav Wilding and Nick Stapleton, the presentation disappoints in that no conclusive result by way of arrests or convictions results.

Kolkata appears to be the hub of these operations. The local Kolkata government has had little success or perhaps even interest in eradicating this crime of international fraud. Perhaps our respective governments should act in the public interest based on the data unearthed by our BBC'S investigative reporters.

Allan C Steele, Giffnock.

Time for 't'

AM I alone in being extremely annoyed and disgusted at what BBC Radio Scotland is providing? Some presenters are professional and excellent with perfectly-spoken English and diction. Others? I despair. Some unable to use proper grammar, slovenly speech and a new afternoon presenter clearly has lost the use of the letter “t”. She is an embarrassment to intelligent Scots and we deserve better. I hope management take note.

Douglas Cowe, Newmachar.

Camley and a patient outlook

I HAVE long been an admirer of Steven Camley's cartoons. His skill in drawing instantly-recognisable caricatures of famous folk with a mere couple of strokes of the pen is marvellous.

I also scan his images for small details, again with minimal pen work, but always appropriate to the subject. This morning's cartoon (November 29) really resonated with me. The queue of people hoping for help at the Finance Secretary's surgery was brilliant. But one small detail said it all. The clock on the wall showed barely five past eight, and all the surgery appointments already gone; an experience surely shared by most of the population.

Neil Scott, Edinburgh.