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At the heart of general practice since 1960

Dr Naomi Beer: ‘We cannot let practices be forced to close'

Dr Naomi Beer’s anger at Government policy on struggling GP practices saw her lead a campaign forcing a crucial concession from NHS England. But, as she tells Sofia Lind, the battle to prevent closures goes on

Dr Naomi Beer

CV

Age: 51

Family: Four children of ages ranging from 16 to 24, the youngest aspiring to be a doctor herself

Education: Trained at Guy’s Hospital and did her general practice vocational training scheme at the Royal London Hospital and at Jubilee Street Practice.

Career: 1992 - present: GP at Jubilee Street Practice, including being a GP tutor. Elected to Tower Hamlets LMC, effective this month

Career high: Leading the east London Save Our Surgeries campaign alongside Jubilee Street practice manager Virginia Patania to secure funding for 22 GP practices at risk of closure because of MPIG funding withdrawal. The campaign has won the support of local patients, MPs and Tower Hamlets Council as well as the RCGP and BMA

Other interests: Frequent attender at the National Theatre, enjoys the ‘rare treat’ of reading a book and is an active member at the local church, where music is ‘another passion’

In the space of just a few months, east London GP Dr Naomi Beer has gone from being a low-profile, hard-working GP partner to spearheading the fight against the destabilisation of general practice in England.

In that time, Dr Beer’s impassioned campaigning has succeeded where official GP representatives have failed since the announcement almost two years that the minimum practice income guarantee (MPIG) would be withdrawn over seven years, in winning support for practices faced with funding cuts.

By mobilising patients onto the streets of the London borough of Tower Hamlets and leading a rally to 10 Downing Street, the Save Our Surgeries campaign has challenged the portrayal of GPs as overpaid profiteers. And it has prompted the Government to take real action, with NHS England last month offering a two-year reprieve to those practices most heavily affected by the seven-year phase-out of the MPIG.

With her dignified and determined approach, Dr Beer has become the human face behind that success – helping the public to understand the plight of practices and how it will eventually affect their ability to see a doctor when they need one.

Concession

While the concession is not exactly what Dr Beer was fighting for – her campaign specifically calls for a long-term funding solution and not a ‘sticking plaster’ – this represents an undeniable victory for GPs and patients in Tower Hamlets.

Dr Beer particularly believes it sends a message to those disheartened GPs  who argued when Pulse launched its Stop Practice Closures campaign last month that ‘we should let practices close’ to make the Government learn the hard way how their policies affect their voters.

‘GPs have been backed against the wall and are angry at the position we have all been put in and the way we have been treated. I can understand some people saying, out of desperation, that isn’t it better that some practices fail,’ she says. 

‘But I would argue so strongly against that because the practices that initially are going to be affected are serving very vulnerable populations.

‘If you let those practices go you cannot replace the level of care that we are giving and that means that you are condemning a whole group of the population to having a lesser standard of care than they are receiving at the moment. I think that is totally irresponsible and we cannot let it happen.’

With admirable calm, Dr Beer explains how she and her practice manager had to move quickly when they discovered in March – three weeks before she was due to sign her new contract – that the practice would be forced to close within a year on its current level of funding.

They secured a meeting with the NHS England local area team, at which the stark truth emerged that the area team could do nothing at all to help.

‘It was very clear that there was no money and no support because we had already done everything they considered relevant to support ourselves.

‘We are a practice that is already working in a network and that has already trimmed down a lot of our staff to create a good skill-mix and reduce the cost of having a lot of GPs. We have invested heavily in our staff to have a physician’s assistant, a healthcare assistant and highly trained nurses. So we have done pretty much everything we could have done to ensure efficiency.’

Drastic action

Faced with two options of either closing or drastically reducing staff, the practice went with a third – to make as much noise as it could.

After approaching local Labour MP, Jim Fitzpatrick, Dr Beer was amazed when he was able to organise a meeting with health minister Earl Howe and NHS England.

Dr Beer recalls: ‘We presented our very detailed position papers, and Earl Howe was very sympathetic. He said: “Clearly you are an excellent practice, clearly you are delivering a high quality of care. No, I am not sending you back to make more efficiencies because I can see that there aren’t any to be made. I am committed to finding a solution for you”.’

NHS England had originally promised to support practices as it phased in changes to the MPIG, but Pulse later learned that area teams had failed to offer any extra funding to those affected by the swingeing cuts. Dr Beer said a representative from NHS England visited the practice but was only interested in what made their surgery unique.

She says: ‘We felt that this was potentially a rather divisive manoeuvre but we agreed to describe what our practice did, and we let other practices in our area know what was going on.’

That was the last the practice heard from NHS England until last month’s announcement of the two-year reprieve. Despite the U-turn, however, Dr Beer is clear that the fight is not over.

High on her agenda, she says, is to ensure the Government sorts out the Carr-Hill formula, which decides weighting of GP funding based on demographics.

‘Equity is a meaningless word when you are talking just about age and numbers of patients, because that is clearly not the whole picture. Healthcare needs surely depend on how sick your population is. If you’re only basing it on age, and especially patients over 75, and our patients are dying 15 years younger than that, it is very clear that we will be massively disadvantaged.

‘None of this formula actually makes sense.’

Foot-dragging

While the Government began working on the Carr-Hill formula to take account of deprivation back in 2007 and announced a fresh review in 2012, nothing has yet happened to change it and the latest review group had yet to commence its work in earnest on Pulse’s last check.

‘This evidence has been around for some time but, for whatever reason, nothing has changed as yet,’ says Dr Beer. ‘Frankly the Government has shown no interest in areas of deprivation because they have allowed this to happen. They’ve done nothing until we pushed them, absolutely nothing.’

So with one win under her belt, Dr Beer is determined to pursue her battle. Asked if she wishes to add any other messages, she fixes her gaze earnestly and says: ‘I would like to encourage people that it is possible.’

Q&A

What would the effect be if your practice closed?

Patients would lose the personal investment of the partners, doctors and staff, many of whom like myself have been here for many years. I believe we are incredibly efficiently run and give an amazing service with the resources we have had.

What has campaigning cost?

Initially all the GPs in the area put money into a pot. We have even had donations from outside this area – a Pulse reader donated some money – and we’ve had donations from the public on marches and rallies. But it’s mostly people’s time that they are giving. My practice manager and I have devoted a lot of hours to this campaign and I’ve had to keep my clinical focus too.

Have there been difficult decisions?

It was difficult deciding how to explain this to patients without raising fear and anxiety.  But we felt it was only fair that patients understood the position and had the choice about what to do. Overwhelmingly they have chosen to support us and stay with us.

 

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Readers' comments (4)

  • Vinci Ho

    (1)First of all , there is a difference between closure of practice due to very poor standard ( obviously identified by CQC) and closure of those many other practices under the influence of this fallacy of efficiency saving.
    Money is a tool for GP practices to work . Take away the tool , how can one even talk about efficiency.
    (2) So closing down the practices, what will happen ? Here comes section 75 , HSCB, ladies and gentlemen . The attitude and behaviour of this government is clear : cheaper , the better.Private providers , no matter what , still have to make profits , understandably to answer to share holders for those 'big guns' companies. The end result could even be some smaller , crappy , providers with no market shareholders, winning a contract to run a practice . It will over-promise by any means to satisfy the commissioners , pis**d off as soon as certain profit is made.
    (3) Again , those with no virtue holding high position in hierarchy , spread the evil through the most . The evil is called sec 75, mate .
    (4)Let this ice ball roll on to gain more momentum amongst people . Let the public realise the consequence of practice closure is an uncontrolled , open procurement to all private providers which will still try to make profits despite ridiculously low funding from this government . Thanks to the 'greatness' of section 75 of HSCB.

    The reason why men enter into society is the preservation of their property, and the end why they choose and authorize a legislative is that there may be laws made, and rules set, as guards and fences to the properties of all the members of the society, to limit the power and moderate the dominion of every part and member of the society. For since it can never be supposed to be the will of the society that the legislative should have a power to destroy that which everyone designs to secure by entering into society, and for which the people submitted themselves to legislators of their own making, whenever the legislators endeavor to take away and destroy the property of the people, or to reduce them to slavery under arbitrary power, they put themselves into a state of war with the people, who are thereupon absolved from any farther obedience and are left to the common refuge, which God hath provided for all men, against force and violence. Whensoever therefore the legislative shall transgress this fundamental rule of society, and either by ambition, fear, folly or corruption, endeavor to grasp themselves, or put into the hands of any other, an absolute power over the lives, liberties, and estates of the people; by this breach of trust they forfeit the power the people had put into their hands for quite contrary ends, and it devolves to the people, who have a right to resume their original liberty, and, by the establishment of a new legislative, (such as they shall think fit) provide for their own safety and security, which is the end for which they are in society........
    John Locke, Second Treatise on Government , 1689.

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  • Govt wants NHSE QUANGO to control all practices by running them themselves, or devolving to APMS, whoever that may be. ?GPs with lofty business skills, Richard Branson etc. They want all remaining GPs to be salaried or locums. Then they will titrate salaries downwards & 'nationalise' locum fees to fixed rates. What will we do about it? Nothing, as usual. Doctors are far too conservative to stand up to this en masse. We need a new, powerful, polarised union, that actually has some b@lls. Govt & public will only sit up when there's a recruitment crisis PLUS strikes that actually have some effect. Any takers? Nope, I thought not....

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  • So what is the action nhs England took and is there some inference or precedent set here for other practices

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  • Yes we can and we should.Until the public feels the pinch of a real GP shortage nothing will change

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