Published: 30/05/2002, Volume II2, No. 5807 Page 22 23

Steve Ainsworth (Yorkshire terrier, 9 May) rightly calls for concentration on fundamentals, rather than peripherals which presently plague the NHS.

An example of this would be for inner-city neighbourhoods to have neighbourhood clinics.

In these areas, GP surgeries and visits often criss-cross each other over half-a-dozen streets, while another dozen streets are deserted, leaving the NHS to parachute suitable cover in.

Such neighbourhood clinics could be run by nurse consultants, with paramedics and other ancillary and care support providing a first-call NHS facility. Covering the whole population of, say, 3,000 within their area, they would filter out most of the estimated 80 per cent of unnecessary visits to GPs.

This would leave GPs to staff infirmaries, which could cover about half-a-dozen clinics, offering minor-operation theatres and recovery and observation beds.

With some GPs as consultants, the 40 per cent of wasted referrals to district hospitals could also be reduced, leaving the latter to concentrate on genuinely acute and special cases.

Combine this with an athletics programme provided by schools and local authorities, and my guess is that most of the 600 million prescriptions presently used would be left untouched.

Furthermore, putting health maintenance into the illness equation would save a huge chunk of Derek Wanless's projected£184bn spending on the NHS.

Alan Spence Member of the disbanded Local Participation Group Camden and Islington primary care group