Proposals to charge GPs the cost of treatment of people who visit accident and emergency departments and walk-in centres 'inappropriately' are very worrying, writes Gordon Lishman

Patient needs, not organisational divisions, should be at the centre of any proposals to reform NHS services. Older people make more visits to their GPs than other adults, and often value a strong, sustained relationship with their doctor.

Charging for patients who use emergency services could make older people feel reluctant to use them for fear of jeopardising their relationship with their GP. Any changes must ensure older patients can access services when they need them, and not at the convenience of service providers.

Gordon Lishman, director general, Age Concern England