The overwhelming majority of medical consultations are between patient and GP, and only a minority lead to investigations.
Most of our healthcare needs are in the last years of life, when age and illness limit our mobility.
When mobility becomes a problem, patients change, reluctantly, from the GP that they have known to a nearer practice. Larger units, however marvellous the facilities, do not compensate for being further away.
If we are old, chronically ill, dying or afraid, we value the continuity of care that general practice has traditionally given more than anything.
It is particularly important for those with impaired ability to express themselves in English, whether because they are foreign or intellectually impaired. It assists understanding, both linguistic and philosophical, and trust and confidence.
The problem for GPs and their patients is less the journey to a hospital department than the delay in getting the report to the GP, which can be several weeks. Other hospitals, Milton Keynes General Hospital for example, have overcome this through technology.
The term polyclinic is loaded with myth. Polyclinics are associated with the Soviet Union, generally negatively, and with Cuba, generally positively. However, it was because the polyclinic system failed to provide effective family and preventive care that Cuba started its family doctor system in 1984.
I hope that the apparent advantage of the proposed changes will be weighed against the clear and serious disbenefits.
Dr Judith Harvey, Camden, London.