‘This surgery will be closed on Wednesday afternoon; in event you require medical attention on that day please ring 111’.

This notice is displayed at my GP surgery, which is going to be open for four-and-a-half days out of seven this week at the height of winter. What sort of signal does this send to colleagues at the accident and emergency department at Southampton General Hospital?

Political parties are competing to promise to spend money on the National Health Service after the next election. But does anybody have a practical plan to improve the basic service?

For most people to benefit it has to start with a good medical service to the community. This means seven-day access to a GP (or equivalent) and a quality night visiting service.

This would allow emergency medicine to cope with the serious accidents and patients who fall seriously ill, for example with heart attacks and strokes.

The second area that needs immediate practical action is the removal of obstacles to the discharge from hospital of older people, particularly those over the age of 75. The vast majority need good social care to settle them back in the community and then to keep them there with a high quality service. This care needs to be paid for from the hospital budgets. This is the only way to get progress in this area, coupled with more accomodation with care for those who have dementia.

To achieve these actions there needs to be a new mentality among professionals.

There is much talk about combining the NHS budget with that of social care (held by local authorities). To be effective it means a real transfer of money from hospitals to community medicine and social care.

To re-balance the system there will have to be reduction in activity in hospitals but a combined service would prevent many admissions. Seven days a week surgeries in the community would be expensive but at present only 7.5 per cent of the NHS budget is spent on the GP service.

If the NHS is to be ‘saved’ it needs simple, practical and real change!