We take out health insurance when travelling, yet freely treat visitors able to pay

When Mrs Thatcher's new policies were introduced I was working in a GP practice in London and saw at first hand the consequent destruction of our health service.

Overnight healthcare was moved from primary objective and replaced by market forces so beloved of that government. Performance tables ruled, as was the case in all public service "industries" (as if it was possible to plan and budget for the "market" for healthcare, policing, the fire service and education).

These services - to justify their existence and secure their funding - were obliged to spend a vast amount of their time on tables and reports which, in any event, were not a reliable way of forecasting performance and future market demand. A supporter of these policies might say that they were instigated to weed out inefficient and inadequate performers. I think that the many scandals involving, for example, inept, fraudulent and unethical consultants, GPs and pharmacists within the health service have shown that they do no such thing.

There have been many cases of GPs asking for patients to be removed from their lists, and there is a very simple explanation for why this is happening. Previously GPs were paid a small fee for each patient on their list and further small fees for: innoculation, vaccination, cervical smear tests, and so on.

Under the new system patients registering with a doctor are not recognised by the paymasters unless they have undergone "new patient checks" - height, weight, blood pressure and urine test. This takes time and often patients express irritation when requested to attend the surgery for these checks, being reluctant to take time off work when they are not ill.

In large cities with floating populations patients may change GPs on a regular basis and each time they will be expected to undergo these checks. As for fees for services provided, under the new system GPs are told which of their patients are eligible for innoculations, smear tests, etc. To receive any payment for providing these services GPs must ensure 80% of target is achieved.

Can you imagine the time and effort involved in chasing patients and getting them to the surgery to carry out these checks and procedures - and yet the practice income depends on these figures (which in any event may be inaccurate due to the floating population) being met.

In hospitals the funding for nursing care is designed to the advantage of private nursing agencies. Budgets for permanent staff are low, and high for "emergency" (ie, agency) staff. This is why the NHS hospitals are now staffed by such a high proportion of agency nurses.

The system whereby 80% of patients are not required to pay for their prescription is unfair, dangerous and open to abuse with patients, for example, requesting prescriptions for people who are not the end-users or requesting NHS prescriptions to replace private prescriptions because they are exempt from charges. By the simple expedient of charging everyone ?1 per item (remembering that GPs can write prescriptions for three months' supply) this could be remedied and costs reduced.

Lastly, there is the subject of eligibility for healthcare. It is scandalous that there is no adequate system within the NHS for checking elibibility and charging fees where necessary. Regrettably foreign visitors to this country assume that they will receive free healthcare - and by and large they are correct in this assumption.

Why is it that we go to great efforts to take out health cover insurance when travelling abroad and yet accept that healthcare is freely given to visitors here?

Even when healthcare is provided on humanitarian grounds there is no system for recouping costs where possible. The Maltese couple who came to England with their conjoined twins, for instance, not only received free healthcare but also had all of their legal fees paid when they took the hospital in question to court. They went home with a healthy and happy baby, thanks to that hospital, and subsequently sold their story to the media for a large sum. I do not believe it is unreasonable to expect them to reimburse the hospital and pay for the legal fees they incurred.

Two friends - one from Qatar and one from Brazil - both attended the A&E departments of my local hospital and wanted to pay for their treatment. There was no system in place which allowed for this possibility.

I started by laying the blame for the collapse of the health service at the door of Margaret Thatcher. This government, with its enormous majority, has had ample opportunity and time to reverse these policies and introduce some new ones along the lines indicated above.

The fact that they have not indicates to me that they are as driven by the idea of a market economy in service industries as the previous government. It is an unhappy and impossible position to adopt and I have no hope that the taxpayer (whom opinion polls show to be perfectly willing to pay higher taxes to secure public services) can expect an improvement in the present situation.