Plymouth: Where ‘no practice is more than a couple of episodes away from closing’
Our new ‘Postcards from the edge’ series features the towns where general practice is on the brink of collapse. Carolyn Wickware travels to Plymouth, in south-west England
GPs in Plymouth are finding themselves under increasing strain, and in a dilemma.
How much of a fuss can they make about the dire straits they find themselves in without scaring away the GP recruits they so desperately need?
‘It’s really important that we start to get people enjoying the locality, enjoying the work we do,’ says Dr Alan Holman, a GP partner at Roborough Surgery.
‘We’re not going to get people coming to Plymouth if all we do is continuously talk about how bad it is down here. There are other areas of the country where it is equally bad.’
But there is no denying practices are struggling. A fifth of local practices have handed back their contract in the past three years, leading to a mix of practice closures and takeovers by primary care provider Access Health.
Four hours' sleep a night
Dr Rachel Ali, medical secretary of Devon LMC, says it’s the result of a ‘perfect storm of workforce and workload issues’ that GPs in Plymouth saw coming 10 years ago.
She says there are practices in Plymouth where a few remaining partners have seen their workload spiral out of control and ‘are getting four hours sleep a night because they’re up doing work there’s no one else to do’.
For Dr James Boorer, a GP at Pathfields Medical Group in Plymouth, it’s meeting his patients’ mental health needs that he finds most draining.
‘Our patients are from more deprived backgrounds and so are more likely to have mental health issues’, he says. ‘Our mental health services see patients with adult ADHD and ASD but they have no funding for this.’
He adds that these sorts of pressures have a small but ‘additive’ effect on the pressures facing general practice.
'As one practice breaks, the pressure on the surrounding practices increase and you can get a domino effect'
Dr James Boorer
‘When things start to break, they break in the weakest areas and as one practice breaks, the pressure on the surrounding practices increase and you can get a domino effect,’ says Dr Boorer.
His practice has tried to steel itself by expanding its workforce outside of GP recruitment.
‘In terms of looking towards the workforce of the future we’ve diversified - we’ve got almost as many nurse practitioners as doctors,’ he says, adding that this has taken some of the pressure off.
But Dr Peter Dunne, a GP at Peverall Park Surgery, says there are small practices in Plymouth ‘where the partners are set on retiring and they haven’t recruited for five years’ that will ‘inevitably fold’.
He adds: ‘No practice is more than a couple of episodes of ill health or a GP relocation away from closing.’
Dr Holman says one of the issues particular to the southwest is that ‘many medical staff are tied in as couples’ with one a GP and the other a hospital consultant.
‘We’ve a GP whose partner is a registrar in a hospital. We’re keeping our fingers crossed that there’s a consultant job in Derriford at the right time and want to stay. If they move - another GP leaves,’ he says.
This isn’t as big of a problem in London, explains Dr Ali, where ‘whichever trust your consultant partner ends up working at, you can stay in the bit of London that you like working in as a GP’.
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NHS England has tried to help, with a recent visit from its chief executive Simon Stevens, and promises of 12 ‘golden hellos’ worth £20,000 each in an attempt to attract GP trainees.
The GPs are aware that it will be five years before they know whether that is an effective way of improving the GP workforce in the area and there’s no guarantee they’ll stay.
The situation in the city has caught national attention with Dr Matt Best, vice-chair of the western sub-committee of Devon LMC, telling GP leaders from across the country at the LMCs conference that practices in Plymouth are being ‘sucked into a black hole’.
But perhaps the most concerning thing is that this is happening across the UK.
Dr Ali says: ‘We’re not unique. We’re the first part of leafy green southwest that’s experienced this. That’s where it’s really surprising people.
‘A lot of people in the rest of the country don’t realise the kind of deprivation that we deal with in Plymouth and in central Cornwall. But we’re certainly not alone.’