I read with interest Steve Ainsworth's article 'Phoney wars' (15 October). Although the original intention of the writers of the appropriate part of the Statement of Fees and Allowances (SFA or 'Red Book') was that 'telephone advice' would not attract a fee, it is unimportant as the wording did not support this (it was written when telephones were less common, and patients were less 'telephone literate').

Consider how GPs are remunerated. At present they are independent contractors and provide services under contract to the NHS. Providing telephone advice to temporary patients is work - it involves time, expertise, appropriate paperwork and clinical notes, and the GP develops a duty of care for the patient and therefore is open to legal challenge (and NHS and General Medical Council disciplinary procedures). It is therefore perverse for such work not to be paid for.

The original wording of the SFA was ambiguous - mainly because it was written before telephone advice was common - but its interpretation would seem to include advice given by telephone, and this has been supported by the NHS Appeals Authority on several occasions.

The NHS Executive tried to 'resolve' the matter by issuing changes to the SFA effectively disallowing telephone advice to temporary patients. This has resulted in an unfortunate position. Now when a temporary patient telephones for advice I and most of my colleagues refuse - all we can offer is to see the patient face to face. This results in disillusionment of the patients with the NHS (and when explained, recognition of a rationing of the service).

In future the NHS must cope not only with telephone advice but also consultation via the Internet or by video telephone facilities. The NHS must embrace new technologies and new ways of working (including funding them appropriately), and not adopt a head-in-the-sand approach.

Grant J Ingrams

General practitioner


Left hanging on: original SFA wording was ambiguious