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Do you experience a patient doctor divide?

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It was with great interest that I read a recent commentary in the Evening Standard (Simon Jenkins, March 23) detailing issues with the British and in particular London health care system under the "over-centralised" NHS. The article raises some interesting issues in the light of Barack Obama's successful changes to American health care. Jenkins portrays himself as a lost fan of the NHS, one, of potentially many, who see's that the NHS has become a bloated system that is out of touch with the patients it serves.

The article raised one very important point when looking at health care at a local level, that most people today have lost or never had a known relationship with a local doctor. It seems, according to Jenkins, that the days of having a local doctor whom you can call on when needed and expect to see in a reasonable amount of time is disappearing. In a similar vain, services delivered out of hours and home visits also are becoming less available. Some of these experiences are ones which I have experienced myself and are an important measuring stick of a health care system. At the end of the day, the most important issues to health care users are ones at a local level, outside of the big national guidelines and initiatives.

So it is with this that I put the question out - what would you like to see improved in your local health services? What experiences have you had that you believe could be improved?