I WRITE about the headline on missed appointments.

As a busy GP it is not time wasted. I keep going using the time for urgent script requests and phone calls. Charging would deter the sick patient from attending.

We would miss early diagnosis. GPs are not paid per appointment but a flat fee annually to provide open access care.

The five million figure is therefore theoretical rather than real.

It is irritating, but I am opposed to charges. The crisis in GP land is not the fault of patients.

There is an access issue with GP surgeries closing and difficulty getting appointments. This is due to a total failure in centralised workforce planning.

The British Medical Association warned of an impending crisis in 2014 but national policy then made the situation worse.

We lost many fine aspiring doctors who gave up medicine following a bruising strike over an imposed new contract.

The NHS has always welcomed and relied upon doctors and nurses who trained overseas. In the last few years the hostile environment has seen many leave and others being repelled. Finally, there have been pension changes that penalised older doctors, many of whom retired earlier than planned to avoid hefty bills.

All in all, it has been a slow-motion train crash.

The answer must be recruitment and retention of more doctors, nurses, pharmacists and physiotherapists.

Forcing patients to use smart phone triage software is seen by some as the way ahead.

This may work well for London commuters but the people who need doctors most are elderly and infirm. They need a personal touch not a computer screen.

I hope that the promised 6000 extra GPs and 50 000 nurses arrive soon. We need them.

Dr Jon Orrell

Royal Crescent Surgery