Dear Editor ,

Not all doctors would agree with Lewis Morrison who stated on your front page on Monday that the SNP pledge to keep the NHS local is dishonest. While nobody disagrees that appropriate centralisation is essential the management of the majority of patients, especially the elderly, is most often best managed locally both for the
patient and their relatives.

Your leader states that patients’ needs should be the priority but the hospital doctor fails to take this view and insists that all must travel to the centre for assessment and treatment. There is increasing evidence that it is safe, and in the patients best interests, to be properly assessed and treated locally. General Practitioners working at the Vale of Leven Hospital in Alexandria, and the Mid Argyll Hospital in Lochgilphead, manage many patients in a local setting. There is increasing evidence that appropriate local management is both safe and convenient for the majority of patients presenting to a general practitioner or minor injury unit. This evidence has not been properly collated and requires wider testing to establish the safety of a model of local care with transfer by a recovery team to a centre when clinical indicators, and the patient’s wishes, indicate the need for intensive care or urgent detailed investigation.

The SNP has been bold in presuming against centralisation and has provided funds for a national retrieval service for seriously ill patients. Scotland has an opportunity to show the world how appropriate local care, with primary and secondary care working together, can provide a safe, sustainable and cost effective care for our rural and urban population. This however requires a change in training for general practitioners and nursing teams together with support and a change in attitude from consultants in hospitals and Health Board managers.

Yours sincerely,

Dr.Patrick Trust.
(retired GP)