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At the heart of general practice since 1960

Beware the super-practice soggy bottom

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As you read, the memory may be fading. But as I write, it’s still raw with me. First, tears over Nadiya’s emotional Bake-Off victory. Then sobbing as we realised the series was over. Finally, wailing in fear of what was to come.

Because where there was sweetness, there is now Alan Sugar. But that’s where the similarity ends. Bake-Off embodies goodwill, community spirit and simple pleasures, all against the backdrop of the British summer. Whereas The Apprentice is a harbinger of winter gloom, with inflated egos jostling for Sir Alan’s attention, not in the hope of making a nice Battenburg, but shedloads of cash.

This leap from people-eat-cake to dog-eat-dog is a real culture shock. It’s also a metaphor for the state of general practice. It is though, isn’t it? At least for the purposes of this column.

To explain. Pulse has highlighted the rise – in number and architectural scale – of ‘super-practices’, comprising scores of partners and massive patient lists. Across the country, the movers and shakers are trying to outdo each other, with the latest declaring an incredible list size of 275,000 patients. And partners? Two hundred. Blimey. We’ve only got six and we still can’t agree on the biscuits.

Do we want to be part of the community or part of the skyline?

These uber-practices will inevitably have a hierarchical structure with executive teams, partnership boards, subcommittees, ‘dynamic’ leaders and so on. They will chime with current political thinking and be in a position to exploit the prevailing funding streams. They will have ambitious plans to expand, embrace the Five Year Forward View and feature sharply dressed individuals who know what ‘MCP’ stands for. And, despite soothing words about tradition and local needs, they will be seen as huge, faceless, soulless, corporate structures employing staff just doing a job on behalf of a disenfranchised population. There’ll be some hiring, but probably quite a lot of firing.

All very Apprentice.

Now, we’ve all been aware that the days of the singlehander are numbered. But suddenly, it’s our traditional small group practice that’s under threat. You know, the one that’s been there for years, has an identity, serves the community, employs staff that patients and doctors can name, gives a sense of vocation and provides continuity. And only occasionally shuts up shop so the senior partner has time to ice his buns.

So are we really at the Bake-Off/Apprentice crossroads? Do we want to be part of the community or part of the skyline? Or is there a middle ground?

Maybe. Remember federations? They were originally the solution to a problem no one could quite identify. Now their time has come. We can capture the zeitgeist by banding together, benefiting from extra clout and economies of scale, but still maintain our identity and our local functionality.

In reality TV terms, then, that would be some sort of hybrid – ‘The Great Apprentice Bake-Off’ – in which the most obnoxious apprentices are bundled into an oven for a couple of hours, then fed to the needy at a local fête. I’d watch that.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (12)

  • I think Silent Witness might be a better metaphor as a few eminant people pick over the bones trying to find out what went wrong with Genreal Practice

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  • Forgive me, but isn't that effectively what the biggest is doing?

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  • Super-practice or federation - what's the difference? Bunches of GPs taking on the risk and responsibility for the massive financial deficit in the NHS. All herded together and following the paradoxical delusion that by being part of a larger group, they can retain their autonomy. Am I the only one who gets it?

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  • Russell Thorpe

    People are running around like Henny Penny shouting "the sky is falling!" Actually it isnt, we just need to get primary care back on track, to where there is a strong connection between the GP and the patient. Doczilla is the wrong way to go and secondary care will not cope with the consequences.

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  • Ricardo Gaudoin

    It will not be long before we return to the Northern, Southern, Eastern and Western Health Authorities-with CCGs returning to PCTs when these 750K patient practices reach the 1-2M mark.

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  • This blog could have been written when the OOH co-ops were forming 20 years ago. They worked despite a lot of scepticism

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  • Tony. How about another book soon. I need something to give me a good laugh and keep me sane. Great columns every week. Keep it up.

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  • Looking at Federations is a solution but without the financial backing and staff in the key positions supported like 'back in the good old days'...it will crumble with the False economy and hopes! Timing is everything.

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  • Small corner shops fell foul of supermarkets.

    Supermarkets are still the principle purveyors of food stuffs alongside the new "convenience" stores (own and branded by the big retailers).

    People do not care how the system is organised as long as they get easy access to the retailers offerings conveniently and at a price they can afford.

    Looks like the same process is happening in the world of General Practice. General Practice is dead. Long live General Practice.

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  • There is no need whatever for a GP except as a personal 24/7 doctor
    Unless we go back to this or something very like it we are dead me walking

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder