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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

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plymouth

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.’

Medical couples

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’.

unp cogora 38516 plymouth022

unp cogora 38516 plymouth022

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.’

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Readers' comments (11)

  • Cobblers

    'Partners are getting four hours sleep a night because they’re up doing work there’s no one else to do’

    Why do I despair at this?

    Come on peeps just because there is no one else that can do it DOES NOT make it your problem especially if, as a result, you are making yourself ill with four hours sleep at night.

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  • Took Early Retirement

    Quite: if the local w/l for THRs becomes years long, are GPs going to start doing them in their "spare" time on the kitchen table?

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  • The Plymouth GPs should move. The systemic strain and dangers are not taken into account by both the GMC and the courts. Gross Negligence Manslaughter is just round the corner. After getting 4h sleep, you will be criticised for working when unsafe due to a lack of sleep and hence guilty for the error.

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  • Coming to a town near you soon......
    It’s only long term leases and “last man standing” bankruptcy fears that are keeping burnt out partners on board their sinking ships. The deliberate destruction of partnerships by a government without a Plan B is an utter disgrace........but one that the press and public are only just waking up to.

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  • There are a lot of leases that will no be renewed in the next few years as the collapse ensues.

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  • THE GOVERNMENT IS ULTIMATELY RESPONSIBLE FOR PROVIDING HEALTH CARE TO THE POPULATION NOT GP PRACTICES-THIS IS THEIR MESS AND I DEMAND THAT THEY AND NOT THE PRACTICES IMMEDIATELY SORT OUT THIS PROBLEM...."IT IS NOT EASY" WILL BE THE BLEATING ANSWER.....WELL BLOODY HARD LUCK, THEY CAUSED THIS MESS AND THEY MUST CLEAR UP THE MESS.

    TO GP PRACTICES IN PLYMOUTH....THIS IS NOT YOUR PROBLEM....STOP TRYING TO LET THIS GANGSTA GOVERNMENT OFF THE HOOK...THEY MUST BE FORCED TO TAKE RESPONSIBILITY.

    I PREVIOUSLY TRIED TO SET UP FORMAL PETITION TO CHANGE THE LAW SUCH THAT:

    legal exemptions protecting government bodies over funding decisions are removed. This is in reference to The Corporate Manslaughter Act 2007.

    I E-MAILED PULSE IN 2017 BUT BECAUSE THEY ARE SOMETIMES "BEHIND THE CURVE" THEY DID NOT PICK UP ON THIS CRITICAL MATTER-WITH ENOUGH SIGNATURES THIS WOULD HAVE TO BE ADDRESSED IN PARLIAMENT...RATHER THAN DISMISSING E-MAILS FROM GPs THEY "DO NOT UNDERSTAND", THEY SHOULD HAVE SEEN THE TIMING WAS PERFECT.

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  • so how are Access Health getting on?

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  • Managing on three times as much per patient as the practices were paid prior to taking them over. Yet when asking NHSE for help the original practices were not enjoying support of that sort. So what’s the agenda....?

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  • The plan is working so well that NHSE will only keep cranking up the pressure until each town's primary care needs are served by one or two large companies like Capita or Carillion...

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  • Plymouth is a fab place to work and the people down here are lovely. I have fantastic Partners who are really committed to their patients and the partnership model. I work with a superb clinical team comprising of salaried docs, nurse practitioners, paramedics, paediatric specialist nurse, mental health nurse, practice nurse, pharmacy techs, HCAs and an awesome admin team that keep the show on the road. I love working here!

    What I don't love is working in the current funding model – with a hugely under-resourced primary care sector and mental health sector culminating in late working and working on days off etc. I completely agree with the previous comments that can be summarised as “bail out, let the government sort out the mess they have created” – oh its so tempting, knowing I could walk away from Partnership and do less work as a locum whilst getting paid more! But I’m still in this job for the patients and the staff and for a love of the NHS. My good will is not unlimited though and there will be a time when I do bail out if things don’t improve and I suspect these sentiments are true for GPs across much of the UK.

    I am buoyed up by some help now coming from NHSE – this is very welcome – but NHSE struggle to deliver really meaningful help within the confines of the general practice contract. It’s the GP contract that needs to change to really save primary care.

    I don’t think things are too difficult to fix (although the longer the crisis continues the harder it will be to fix as doctors burn out and leave the country). The whole of primary care, across the country, just need a little more funding. For example if we received just £1 per patient per week extra we would not only save general practice it would revolutionise the breadth and depth of care we could deliver. £1 per week is not much - less than a cup of coffee per week to save and improve primary care and develop a service fit for the 21st century.

    I think it is also time to update the funding formula to better represent the health needs of deprived communities – it is not fair that our central Plymouth patients die about 10 years younger than those in the leafy villages around Plymouth! Delivering an adequately resourced, comprehensive primary care and mental health service would help to address the life expectancy inequality.

    When will the government wake up to the crisis? When will they realise that allowing primary care to fail will not only result in worse outcomes for patients but also massive escalation of healthcare costs: eg: https://inews.co.uk/news/health/virgin-care-gp-practice-rated-inadequate/

    We cannot leave this up to the government. Patients need to start demanding better care. Patients need to accept that a small tax increase is required to save the NHS. We’re not talking mega bucks - £1 per week to save primary care? And are there any other options on the table? Private companies? Private Healthcare? Now that really would be expensive!

    People of the UK – Contact your MP – March - Demand better health care – make your voice heard!


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