Published: 15/01/2004, Volume II4, No. 5888 Page 22

I enjoyed HSJ's excellent leader on patient choice and primary care (page 17, 11 December 2003) .

As a GP, I differ from a number of my colleagues in supporting enhanced patient choice. I think it is right that patients should have access to a greater number of over-the-counter medicines, such as statins, in addition to a wider range of services delivered in community settings.

However, a service that provides people with a choice is not necessarily synonymous with a better-quality service. Patients may choose to have their warfarin treatment monitored in the community, have their skin lesion excised in general practice or have sigmoidoscopy performed in the primary care trust diagnostic unit. But if the warfarin monitoring service has not signed up to the external quality control scheme, the skin lesion is not submitted for pathological examination or the sigmoidoscope used is rigid rather than flexible, then patients are being short changed. Sadly these are all real examples.

PCTs must remember that quality encompasses effectiveness, appropriateness and efficiency, as well as accessibility, acceptability and equity. An ineffective or unsafe service is not a choice I want to offer to my patients.

Dr Nick Summerton GP and head of division of public health and primary care Hull University