Primary reason for GP's elderly care fees 

The Association of Charity Officers has started a debate which should be expanded (Doctors breaking 'free NHS' principle, March 30). The covert privatisation of the care of the elderly has imposed enormous strains on primary care. Within the past decade, hundreds of geriatric and psychogeriatric beds have been closed. The staff (doctors, nurses and administrative) and other resources have not been transferred into primary care - but the patients have. 

Since 1990 two nursing homes have opened in our practice area. Effectively, we are now expected to look after around 100 elderly, often seriously physically or mentally ill patients. To create that capacity in our local trust would cost hundreds of thousands (if not millions) of pounds. The homes surveyed had charitable status; many don't and aim to profit from the NHS discarding long-term care of the elderly. I do not condone charging for NHS services, but does the association condone extra work being dumped on primary care without sufficient resources to cope? 
Dr Martin McShane
Chair, North-east Derbyshire Primary Care Group 
Martin.McShane@tesco.net

The necessity for some care homes to pay retainers to GP practices was first revealed months ago in the nursing journals. This means that, for example, self-financing nursing-home residents must pay fees which not only cover their own care costs, but also subsidise those of other residents sponsored by social services - which are only prepared to pay lower non-economic fees - and make a contribution to the costs of their own and other residents' GP cover. 

Of course residents make greater demands on GPs than patients of equivalent age still able to live independently. They are (or become) just as ill as those cared for in hospital and suffer from a wider range of terminal conditions than the small minority cared for in hospices, where there is "in-house" medical cover. Nursing home care is far cheaper than hospital or hospice and yet those providing it are financed inadequately and reluctantly and the quality of care is bound to suffer. Death may be the great leveller, but terminal or chronic illness most certainly is not. 
Don Aston
Solihull 
Don.Aston@btinternet.com