Ray Wilcox (letters, 26 April) writes that GPs need more management support, which of course GPs need as much as holes in the head.

He berated the one GP in a practice who still refuses to use a computer. Since I have not seen any consultant use a computer in outpatients at my local hospital, other than in the diabetic clinic, he may find it is in that direction that further 'management support' is required. The hospital's diabetic clinic computer is in fact a GP clinical system housed at a GP practice.

General practice is the most successful and efficient part of the NHS, with most of us operating from computerised, clean, modern or modernised buildings, funded by the mother of all private finance initiatives, generally known as the cost-rent scheme.

Beware of all those who call for general practice to be a salaried service in order to get some order and control over my maverick profession. We have changed far more than any outpatient department. GPs breathe their own smoke. We control our own expenses. Our income is pretty well fixed, but our profits are derived from tight control on expenditure.

Introducing more 'management support' and a salaried service is a sure recipe to turn general practice into the financial black hole that the nationalised hospital service has been since 1948.

Your comment ('We have waited too long for an outpatient shake-out', 19 April, page 15) also suggested that GPs take the strain of outpatients. We have been doing that for years, as the number of consultations per patient on our list has risen year by year and reached five consultations per patient on our lists per year.

Gerard Bulger Archway Surgery (PMS) Bovingdon Herts