Suddenly we have been told that NHS Direct will go far beyond an advisory telephone service, with every practice connected to it and direct- access services in main streets and shopping malls, though independent investigators are beginning to question the cost-effectiveness of the basic telephone service.

The level of consultation and explanation to primary care professionals on the whole subject of NHS Direct has been reminiscent of some of the least listening governments of recent years.

If the intention really is to have services in main streets for the convenience of the passing shopper, the planners probably do not fully understand the effects.

Direct-access services will be expensive, as demand-management of prescribing, diagnostics and referrals is likely to be poorer than when patients have an ongoing relationship with their GP.

Consultations are likely to be based purely on presenting symptoms, which may involve considerable resources to little effect.

This consumerist interpretation of the future NHS is entirely at odds with primary care groups, which will be trying to make the best use of scarce resources according to need. If we make access to doctors as easy 'as buying an airline ticket' in an NHS employing fewer doctors than any other European country, we will inevitably make access more difficult for the more needy. What happened to the commitment to health and equity?

If we prioritise easy access for minor symptoms, we will encourage that very culture of dependency we should be trying to change. These proposals betray ignorance of what primary care really is like at grassroots level.

Where are the computers to connect all GPs to NHS Direct? Despite repeated requests from the NHS PCG Alliance, the government has failed to provide any material help for the 50 per cent of non-fundholding practices, which were disadvantaged in IT terms by the previous system.

NHS Direct is being waved in front of the hapless public like a sop, totally at odds with the fundamental philosophy of the present NHS changes.

The government must slow down, share its vision with the rest of us and get wise to what primary care is really about.

Dr Michael Dixon


NHS PCG Alliance