I try hard not to respond to stories in HSJ relating to primary care, especially not to the deliberately provocative comments of the editor in his column, writes George Young

But may I try to stifle Richard Vize's glee as he racks up the costs of attendances at accident and emergency being applied back to general practices?

Practices that have opted out of out-of-hours cover by forgoing that income are not responsible for unscheduled care received during those hours. It is the responsibility of the primary care trust.

By the same token, any practice that ends up seeing emergency patients in its extended hours pays twice: once for opting out and again for being open.

Dr George Young, Hall Green Health, Birmingham