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Singlehanded practice must remain an option

The recent headline 'I want to split the practice and become a singlehander' (October 28) was timely. It may become impossible if and when the framework for our new contract is adopted to become a singlehander.

Even if there was agreement that a practice should split and the colleague be allowed to go singlehanded, how would the patients be divided? Would patients A-P remain with the existing practice and patients Q-Z split off with the leaving GP? I can hardly see this being acceptable. To my mind there is no mechanism where by a singlehanded practice can be separated once lists are pooled.

In fact adoption of the framework as it stands without modification will have an unfortunate ratchet effect whereby practices can upsize easily, but downsizing will be an order of magnitude more difficult.

No individual parts of an aeroplane can fly, but when the various pieces of metal are assembled appropriately the total can take to the skies like a bird. This is an example of gestalt were the total is greater than the sum of the individual parts.

Some partnerships and group practices exhibit what I term a 'negative gestalt' where the total is less the sum of the constituent parts! A future GP can be trapped in just such a practice. It is surely necessary to retain a mechanism to split off in order to increase the total efficiency of the system.

A couple of years ago I looked at singlehandedness in London and found that of the Small Practices Association members who were singlehanded approximately half had split from a larger practice.

Out of the 108 GPs who has split only two of them subsequently wished to forgo their singlehanded status.

Interestingly the reasons for splitting were not, as I had anticipated, to do with workload or remuneration, but were to do with values, which underpinned the GP's work. I do not believe singlehanded practices is the best way for a GP to practise his skills but that it is certainly one of the ways, and without the opportunity to be singlehanded we will lose an important part of our profession.

Dr Michael Taylor

Small Practices Association chair



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