SIR – Councillor Mike Gibbons is right when he suggests it is regrettable that GPs who have locked themselves into expensive telephone contracts expect their patients who are often on low incomes to ring up for appointments while running up bills they can’t avoid (T&A, April 15).

The main cause of this situation is that patients are advised to ring surgeries at a certain time in a morning so that everybody rings at the same time. Trying to get beyond the engaged tone is also extremely frustrating and time-consuming, often resulting in appointments not being available that day, with the advice to ‘ring again in the morning’, with the same result.

Countries like Sweden and the USA have implemented Telephone Advisory Services based on nurse-call systems which have been very successful in managing first-point-of-contact primary care.

Surely with the new GP Commissioning Groups it is time for a full assessment of alternative support services as present systems are not fit for purpose and basically are not in the interest of patients.

Joan Barton, Hill Foot, Nab Wood, Shipley