Published: 31/10/2002, Volume II2, No. 5829 Page 20

Dr Gill Morgan wants a choice of where and by whom she is treated ('On the range', pages 14-15, 10 October).

Two patient groups have no choice at all - the old and the mentally ill. You may loathe or mistrust your area psychiatrist but those whom God hath joined together. . . For good and bad reasons, community mental health teams rigidly enforce their geographical boundaries.

Elderly people may take against a hospital where a friend has suffered, a spouse has died or they had a bad experience decades ago. They may beg to go to St Elsewhere's, but a GP's patient advocacy crumbles under relentless interrogation.

The old and the mentally ill are a disenfranchised majority in today's NHS.

Dr Stephen J Nickless London