Letters: Are there still any reasons to be cheerful?

Doctor’s note

Sir: Your leading article ‘Labour vs labour’ (21 September) follows a recent theme that I have noticed in The Spectator, in which the government is criticised for allowing public pay rises without implementing changes to working practices to increase productivity. I cannot comment on other sectors but I work in the NHS, working closely with junior doctors as colleagues and am involved in training them.

Your article appears to imply that if they worked harder or differently, productivity would improve. While I accept that NHS productivity may not have improved (or may have worsened over recent years), my experience as a GP and trainer is that my productivity and that of juniors is limited by structures and barriers to the efficient provision of care imposed by changes imposed from above. These changes have come from the last government, the Department of Health, NHS England and the wider society, and are completely beyond the control of frontline clinicians, who are as frustrated as the public about the situation.