I NOTE with interest your lead story today (“Unions fury at ‘scandalous’ £10k windfall for doctors” (The Herald, January 12). I am a member of one of the two Helensburgh GP practices. There are five GPs in my practice who have an average of 14 hours and 30 minutes of patient contact time per week. In Scotland, GP remuneration averages £90,000 per year or for the doctors who treat me £119 per hour.

How can this be justified in a world of austerity and a living wage of £8.45 per hour?

Dr Peter Bennie, the chairman of the British Medical Association (BMA) – the doctors' trade union – has given his view: “We have seen staff in NHS Scotland working incredibly hard in extremely difficult circumstances over recent days to deliver the care that people need.

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“I’d like to add my gratitude to the many expressions of thanks that teams across the country have received. But to be honest, it is not thanks that doctors and their colleagues want.

“Instead of gratitude, we need a long term, sustainable plan that closes the growing gap between re-sources – in particular finances – and the demand for services.”

A Government spokesman says “necessary professionals are in scarce supply”. GPs are in short supply because the Scottish Government did not increase places in Scottish medical schools after the European Working Time Directive was passed in 1998. If a doctor can’t work as many hours, either you need more doctors or you have to improve the efficiency of those already in post.

I was a professor at Oregon Health Sciences University, Portland, Oregon, United States. There are 110 places available each year in the medical school class. There are around 2,000 applications for the 110 places, all from qualified students. The American Medical Association, the equivalent of the BMA, restricts the number of medical school places to maintain the salaries of practising doctors. It is not in the interests of the BMA or its members to have too many doctors in Scotland.

Scottish GPs are paid a high salary in part to compensate for the financial risk associated with partner-ship and providing premises. The new contract will remove these financial risks. The new higher salaries will be guaranteed and “out of hours, premises income, community hospital work, enhanced services and other NHS related work will be in addition to this scale”.

In the brave new BMA world, GPs will have time to take on a second, third or fourth job to make ends meet..

We already have banks and bankers who are too big to fail. It seems that we will now have GPs who are too important to fail and must be propped up with huge pots of taxpayer money.

John Black,

6 Woodhollow House, Helensburgh.

PROFESSOR Mike Lean (Letters, January 11) helpfully lays out the sophisticated 1-9 sequence of actions which patients should expect within a four-hour period or sometimes longer on entering emergency departments. The population should be reassured by that. While reports often suggest that patients attend with flu, actually most attend with symptoms which are worrying them or their partner or carer. Typically, apart from injuries and burns, these are prolonged pain, high fever, rigors, breathlessness, blood appearing from an orifice, faintness and collapse or a combination of those. Especially in older patients, these symptoms and signs may represent viral illness, flu being at the more severe end, or from some other disease already known about or presenting for the first time.

From 8am till 6pm weekdays, general practitioners have a responsibility to organise their practices to be able to respond timeously by phone or appointment to concerns and worries about such symptoms. Nurse or doctor phone appointments mid-morning and thereafter or one GP acting as "on-call doctor" for the day should generally meet that need. Unnecessary delay should be avoided as generating worry. Of course receptionists need to be trained and supervised to pass on more serious symp-toms immediately or suggest a 999 call appropriately. Confidence in this primary care service is key to avoiding that unnecessary trip to the hospital.

The access equivalent after hours and at weekends is the answering time for assessment and advice provided by the NHS24 teams. Key clinical indicators are measured against standards of responding within 20, 60 or 90 minutes depending on the urgency determined by the initial questions asked.

Pharmacists can respond to concerns, presumably across the counter, rather than by phone. That will mainly assist those whose problem has not rendered them bedridden or housebound.

Best use of the good menu of services can mitigate the pressures fully described recently. Each health board plans for the winter period and should now indicate whether they were able put all that they thought necessary in place. Did they expect unmet need? The current situation should be compared to previous high-pressure periods. Discussion about all-year-round safe bed occupancy levels and winter staffing planning across health and social work are required to inform managers and politicians what may be required in future.

Social care remains a major concern and the reported Scottish Care survey showing that more than 80 per cent of community care provider firms feel insecure about their sustainability adds to that. I believe maintaining and enhancing care provided in peoples' home and in care homes is our Achilles heel along with the steadily shrinking number of hospital beds.

Philip Gaskell,

General practitioner,

Woodlands Lodge, Buchanan Castle Estate, Drymen.

WITH the Scottish Government expecting NHS Scotland to ensure 95 percent of patients are seen within the four-hour time frame, it's hardly surprising that just 78 percent were seen during the festive period. The Government's unrealistic expectations, combined with underfunding, makes its time frame highly unsustainable.

The spotlight is firmly on our struggling NHS across the UK so we must ensure we give raise and words of encouragement to our amazing, hard-working, overstretched, dedicated health service staff.

On complimenting a nurse in a supermarket, I was told her orthopaedic ward at Glasgow's Queen Elizabeth University Hospital has now been turned into a medical ward, to cope with the excess numbers of flu patients, and the medical complications. This in turn has a knock-on effect of orthopaedic surgery cases being delayed, or postponed when there aren't the beds to give them the aftercare needed.

So if we must be critical, please be aware it's our overpaid politicians who are to blame here, not our excellent overworked frontline hospital staff.

Jill Ferguson,

Crow Road, Thornwood, Glasgow.