ALAN Simpson’s article ("Is it time to think the unthinkable on NHS?”, The Herald, July 11) questioned the NHS funding model and Alasdair Forbes’s letter (July 15) on behalf of the Royal College of GPs in Scotland emphasised how stretched the service is and not sustainable in its current form. Both seek public understanding and engagement around the current challenges and Dr Forbes wants 11 per cent of the NHS budget to go directly to general practice, currently just seven per cent. Patients waiting many days to see a GP may endorse that change if waits shorten.

Public, patient and carer understanding may be helped by some figures and knowledge of the processes. The NHS budget in Scotland is about £2,000 per person per year. An increase of four per cent to general practice would represent £80 per head per year. Average annual GP prescribing ingredient cost per patient is £170. That cost is rising, partly due to pricing changes beyond NHS or GP control.

Primary care prescribing costs are one of the pressure points for stretched Health and Social Care Partnerships (HSCP) along with the demand for social care, nursing home places, complex care packages and savings plans unachieved. Observing my own HSCP board in session last week was salutary. Councillors, in particular, objected to being asked to approve an unbalanced budget for the current year – a projected overspend of £4.6-£7.2 million (£32-£50 per head) forecasted, the ultimate figure dependent on actual costs and the success or failure of a list of costed savings changes which could reduce the figure by £14-£23 per head. Do we really know the detail of these changes and their impact?

HSCPs have control of around 50 per cent of the NHS budget and there was some expectation that savings from in-patient care covered by that budget would fund improved services closer to patients’ homes. In its submission to the Cosla/Scottish Government group driving the further development of HSCPs, my HSCP does not expect that to happen – unsurprisingly given the pressure on emergency departments and in-patient beds.

Where does that leave us? We know that social insurance schemes in Scandinavian countries provide a different funding model and that in countries such as New Zealand with a significantly lower GDP, more families take out private health insurance to reduce long waiting times for specialist attention. Most in the UK agree that income tax is the fairest way to raise tax, National Insurance and property value taxes less so. Council tax charges range from around £1,000-£40,00 per household per year.

Rather than spend time and energy trying to understand the complexity of NHS and social care costs, perhaps we could trust HSCPs and health boards to do their best to control costs while providing fair access to new medicines and treatments. We should also trust clinicians to share decision-making with patients and carers, a principle part of the Realistic Medicine process.

The focus then must be on how much more we are prepared to pay in tax for sustainable services which are free at the point of need – and to use these wisely and sparingly for the good of all.

Dr Philip Gaskell, Drymen.