David Nicholson, the NHS chief executive, has raised alarming questions about how the NHS can be paid for (NHS chief: cuts alone will mean more Staffords, 11 July). Throughout a working lifetime as a GP, I have carefully watched many changes. I now have a pragmatic but retro-radical suggestion: we should abolish the internal market and thus such subordinate institutions and devices as the purchaser-provider split, autarkic and competing trusts, payment by results and commissioning. All of these may be well intended but collectively are a failing experiment to apply commerce and monetarism to complex welfare.

The human and economic costs of this defederalised system are very high. As fragmentation and boundaries increase, so do procedural, bureaucratic and financial complexity and delay. Competition, or its threat, decreases professional synergy and replaces it with expensively expedient tactics and presentations: glossy brochures, specious statistics, mistrustful feints, "gaming" the systems and being guided more by technical legality than humanistic ethos. I have hundreds of examples, but rarely (if ever) do I discern clear benefits of defederalisation.

Here are two commonplace and recent examples. First: my local GPs have cumulatively invested hundreds of hours tendering competitive plans for an out-of-hours centre. This was a politically prescribed project of no real value; it evaporated without sense or trace. Second: at a mental health centre, I attended a dreary meeting where eight fractiously obedient practitioners discussed for half an hour a patient who none of them had ever met; in particular, whether the referral was procedurally correct. Until recently, this would have been dealt with by a friendly five-minute phone call by an experienced practitioner with good sense and courtesy. That way, time and energy were saved, helpful relationships fostered.

Such losses and follies may seem comically grotesque to an outsider: as an insider, I know the enormity of the consequences, the costs to people as well as budgets. Such is the maturing culture of corporatised and marketised welfare. The old, federal, "socialist" NHS did not have these problems. Yes, it had others, but I think they were more honest and more soluble.

Dr David Zigmond

London

• A&E departments may well be unprepared for this winter, but need not be so if the NHS were financed and run sensibly. The budgets for hospital care have moved into the hands of bodies of mostly GPs. There is nothing wrong with that provided that GPs take responsibility for their patients. Research has shown that in practices where patients cannot get an appointment within 24 hours, A&E is the fallback position for 38%; where practices offer a more rapid appointment, that figure falls to 1%.

Surely the clinical commissioning groups should charge GPs for A&E appointments and pass that on to the hospital. A&E would then be able to concentrate on what it is designed to do: serious and immediate care.

Dr Stephen Seddon

Market Drayton, Shropshire

• I note that in your report anticipating the publication of the Keogh Report (NHS officials fear new attack, 15 July) you repeat the canard " … at Stafford Hospital, where between 400 and 1,200 are believed to have died …" I am weary of reading this allegation in the red tops and Tory press, but I draw the line at seeing it in the Guardian. Unfortunately, the allegations have been reprinted so often, without any dispute, that they have been assumed to be the truth. Could we for once and for all clearly state that this simply did not happen?

The full story is a long and complex one, far too labyrinthine to go through in depth here, but the key facts are: Robert Francis refused to include these figures in his report because they were unreliable and likely to arouse public anxiety. How right he was: they derive from the flawed figures devised by Brian Jarman – a ratio measure known to be limited even when correctly applied. In Stafford, the measure was not correctly applied or coded. Computer buffs know the acronym Gigo: garbage in, garbage out. Never more true than here.

In 2009, Dr Mike Laker was asked to conduct an independent review into the detailed case notes of every contentious death at Mid Staffs during the period in question. He and his independent team of expert clinicians examined a self-selected group (one would think the 60 who asked to be reviewed were the ones with most cause for concern) and after a 5-6 month review of each case, found "perhaps one such (excess) death".

For those who would like to read and digest a fuller version, the issue has been brilliantly analysed by Steve Walker here. Why are these figures so widely repeated? It is high time that the true Stafford story was told.

Gail Gregory

Support Stafford Hospital

• As a kidney donor recovering from surgery on 1 July, I am compelled to counter the criticism of high death rates at 14 NHS Trusts. It would be a disaster if adverse publicity affects the willingness of donors to give. The need for kidney donors outstrips demand by at least one to four. About 7,000 people in the UK are on the waiting list for a transplant, according to the Department of Health, and 300 will die this year as they wait a suitable donor. Negative media should not deter those considering donating. The level of care and attention I received was exemplary.

Ken Evans

Matlock, Derbyshire

• The problem with A&E is that it is all we have. All hospitals should have a cuts and bruises facility where you could go as a triage point to be treated/reassured, then either directed back to your GP or on to the hospital. You'd need a nurse and a doctor, a thermometer, blood pressure monitor and a bag of dressings. We don't need a few large facilities treating people with heart attacks alongside people with bee-stings.

Rob O'Brien

Farnham, Surrey