LIKE your correspondents Drs Slater and McNicol, I share their perspective that the contract offered to GPs to contract out of 24-hour care commitment in 2004 is a failure.

This has seen their role as gatekeepers to the NHS, dealing with over 90% of patients’ needs, dismantled, resulting in hospital A&E departments being overwhelmed inappropriately to diagnose and treat patients who should be dealt with in the primary care sector.

Of course, inadequate numbers of GPs, the greater complexities of treatment consequent on continuing advances in health care necessitating longer consultation times, have all contributed to the difficulties and delays in getting timeous GP appointments. This in turn amplifies patient anxiety contributing to their overburdening of A&E services.

There is no turning the clock back to 5-minute appointments, on call one night and one weekend in three including a Saturday morning surgery (one in two when a partner was on vacation). I undertook this in our three-doctor practice for 22 out of 30 years in General Practice. For the latter eight years after midday on Saturdays, weekend on call was delegated to the Glasgow City GP co-operative.

I mention this not to earn a “pat on the back”, but to give insight on the reality of city General Practice in past decades with the ethos that if that was not the vocation you desired or were prepared to do, then a different career path could be chosen. Like Dr McNicol I have given thought on how to improve the current scenario. My experience was also that the vast majority of out of hours calls could be dealt with on the telephone due to insight on the patient’s medical history and with the patient reassured by advice given by a doctor they were familiar with.

With suitable financial recompense provided by savings from the current NHS 24 costs, it is surely feasible for family doctors on a practice rota basis to phone triage out of hour practice calls, and patient scenarios inappropriate for telephone advice referred to A&E or a 999 ambulance as clinically appropriate.

Dr Jon Cossar (retired Glasgow GP), Edinburgh

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Stop knocking heat pumps

IF sensible decisions had been adopted 50 years ago most of the existing houses would be better insulated and more in line with Norway, where almost two-thirds of domestic houses are heated by heat pumps.

This however would have resulted in less profit for the companies building houses and their CEOs are obliged to safeguard shareholders' interests.

A house that loses 25kW of heat will require a heat source of at least 25kW to replace this heat loss, excluding domestic hot water, whether this comes directly from a nuclear power station, a gas boiler or a heat pump.

If you improve the insulation of a property it will reduce the heat loss and reduce the amount of heat required to replace it, again irrespective of the source of the heat.

If an installer does not know how to install a heat pump he will obviously not sing their praises and this along with ignorance has led to a lot of misinformation being circulated. Heat pumps will improve and will become cheaper through time, and technicians will be trained to install and maintain them.

At present the UK Government through Ofgem dictates that the price we pay for electricity is linked to the cost of the most expensive fuel used to generate it and this makes it at least two to three times the price it should be to the customer. Just look at the obscene profits of the wholesale energy companies for proof of this.

With realistic electricity prices and improved and cheaper heat pumps they will be much cheaper overall than gas boilers and no CO2 to potentially destroy our planet. The need for a base load is recognised and is included in any planning just as upgrading the National Grid is recognised. Nuclear energy may be required in some countries but is unlikely to be necessary in Scotland and it is significantly more expensive than renewable electricity.

Hydrogen, which can be generated from surplus renewable electricity, can be generated, stored and used most efficiently at the point of production to power gas fired generators at times when renewable energy is not available. This along with interconnectors throughout Europe will adequately cover these periods.

Once the National Grid is made fit for purpose Scotland will be exporting electricity to other countries; let’s hope it is under our control rather than the multinational companies.

Heat pumps are now available using propane (R290) as a refrigerant which has a water temperature of 75oC which, for interest, is similar to the temperature of existing gas boilers so it is likely that in most cases very little modification will be required to replace gas boilers with heat pumps.

The Scottish Government and the engineers responsible know what they are doing, so stop knocking heat pumps and accept that in the long run there is no realistic alternative.

Iain McIntyre, Sauchie

Read more: Surely now we will waken up to the failings of CfE

Nuclear does not come with huge cost

GREGORY Beecroft (Letters, December 6) is incorrect in his claim that "nuclear comes at a huge cost". The data for the Hinckley Point C (HPC ) unit being built in England shows that the 3.3GW plant will generate around 24TWhours of electricity for 60 years at a capital cost of about £30billion. Compare that to an additional 1.1GW wind farm at Seagreen which, according to Vattenfall, will produce around 4GWhour per year for 20 years thus requiring to be replaced twice to match HPC. It would thus require six such wind farms to equal the lifetime output of HPC at a capital cost of £108bn which means a £78bn saving by the end of the century.

Add on the cost saving for a four-fold increase in electricity generation needed to phase out gas and there is still a profit when including decommissioning costs for HPC-type plant.

Note that Tom Greatrex ("It’s time to end Scotland’s isolation on nuclear energy", The Herald December 5) did not point out in his article that it was politicians who ignored the Swedish model of investing an agreed sum from the profits from nuclear generation into a decommissioning pot but, instead, decided to send the cash to the Treasury with a caveat that the taxpayer would pick up decommissioning costs.

However, on an optimistic note, Mr Beecroft can be assured that few jobs have the 1,000 year security of decommissioning storage work.

Ian Moir, Castle Douglas