Letters: Open boundaries mean more centralisation

To cope with patients far from the practice we will need:

facilities for telemedicine, like the interactive audio-visual telehealth booths coming into pharmacies;

arrangements for home visits to be delegated to the local out-of-hours service; and

awareness that this opens up the possibility of more centralisation of services.

We need to develop into larger organisations that can compete in this market.

Dr Alick Munro, Hounslow, west London

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