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Beware: US-style health care has nasty edge for patients

Health Secretary John Reid advocates that we learn from US health care (News, November 10). Patients will be faced with a new model of general practice that requires them to be more knowledgeable consumers of care delivered by a panoply of providers.

At stake are both universal health care and the tradition of family-centred medicine that has been the hallmark of UK general practice for 50 years.

The GP monopoly over the provision of primary care services in the NHS is to be further broken up. The new GMS contract transfers the control and accountability for primary care services from GPs to primary care organisations and signals increasing dominance of market forces over service delivery.

Reducing the doctor's task to building blocks that can be distributed here, there and everywhere might be efficient, but even if implemented intelligently such an approach could damage that which so many patients and doctors hold dear. The contract potentially opens the door to chain stores employing GPs, to create what the Government says it wants more of ­ one-stop polyclinics giving the same convenient access to NHS services as people currently have to shopping.

Kaiser Permanente is like the NHS, but the NHS with an edge ­ and the edge is you don't get care if you are unemployed or can't pay.

From Dr Kailash Chand, Ashton-Under-Lyne in Lancashire

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