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Rural practice: Buxted Surgery

GPs often complain about the Government’s one-size-fits-all approach to policy and funding. By Gareth Iacobucci looks at the unique challenges faced by a large urban practice and a small rural one

By Gareth Iacobucci

GPs often complain about the Government's one-size-fits-all approach to policy and funding. By Gareth Iacobucci looks at the unique challenges faced by a large urban practice and a small rural one

Traditional family practice has often been described as a cottage industry, and at Dr Clarissa Fabre's surgery, the term applies in a literal sense. This quaint rural practice is located in April Cottage, in the tiny village of Buxted, near Uckfield in East Sussex. Euphemistically, the surgery would probably be described as ‘cosy'.

It houses an entire practice team - three partners, two salaried doctors (one part-time), two nurses, a team of receptionists and a dispensary, all within a somewhat Tardis-like, two-up two-down cottage. This wouldn't have mattered 20 years ago, when the practice was singlehanded and had a list size of just over 2,000. But in recent years the business has grown substantially, with 7,000 patients now registered.

As Dr Fabre explains, patients do love the cottage, and you can understand why – a warm and welcoming atmosphere resonates as soon as you enter. The waiting room has more in common with a living room than a typical practice waiting area, with homey-looking stairs leading up to the dispensary and examination rooms.

The dispensary – which employs a manager plus eight part-time dispensers – is a unique service that reflects its surroundings. It provides income for the practice, but more importantly, it is vital for patients, with no pharmacy in the village.

The dispensary doesn't only service patients at the practice, but also delivers to housebound patients and carries out ward rounds at three local 50-bed nursing homes. ‘Looking after the elderly and infirm is a big part of the job,' says Dr Fabre.

Along with its large number of elderly patients, who generate most of the workload, the practice has a predominantly affluent patient list, including a growing number of commuters. All the enhanced services available locally are offered here, including extended hours, which Dr Fabre says is almost fully subscribed – although not necessarily with working-age patients. Its balance of pre-booked and same-day appointments reflects its patient demographic, with 42% of appointments pre-booked from Tuesday to Thursday and 29% on Monday and Friday.

A wide range of other services are on offer, including a chiropodist who comes once a week. GPs from the practice also do weekly clinics at the local hospital, in areas such as ENT, orthopaedics and arthroscopy.

With the practice having a growing commuter base, some members of the team are concerned the Government's proposal to abolish practice boundaries may spell trouble. Dr David Wright, a partner at the practice for nearly 18 years, says: ‘I'm worried about the impact on the list size.'

Picturesque it may be, but the premises – and particularly its lack of space – present an obstacle to development. Reluctantly, Dr Fabre has decided to relocate, with the practice set to move into new premises down the road in two or three years' time.

As dispensary manager Heather Mather concedes, the current lack of space makes it difficult to deal with the greater number patients coming through the door for prescriptions. ‘We are growing – we get through 10,000 scripts a month. We're not big enough to do as much as we do.'

Dr Fabre acknowledges the need to move with the times, but is determined to try and retain a personal feel. ‘The ethos of the practice is very close and very friendly. It's not impersonal, though people say it's too squashed,' she admits. ‘A lot of new health centres are very impersonal. But we have to move to a more modern surgery – it seems to be the future of general practice.'

Rural Practice - Buxted Surgery

List size: 7,000
Funding per patient: £59.40
Patient demographic: Many elderly patients, but also younger commuters
Location: Buxted, East Sussex
Staff breakdown: Three GP principals, two salaried doctors (one part-time), two nurses, dispensary manager, eight part-time dispensers

Clarissa Faber

We have to move to a more modern surgery - it seems to be the future

Dr Clarissa Faber

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