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Two 'ordinary GPs' take on the multi-nationals

When the new contract brought competition to primary care, Dr John Chisholm and Dr Simon Fradd saw an opportunity.

The two men, who were instrumental in negotiating the contract as chair and deputy chair of the GPC, formed their own limited company, Concordia Health.

They recently won con-

tracts to operate two PCT-run practices in south-east London, beating competition from 23 bidders, including the incumbent GPs.

Here they reveal their plans ­ and encourage other GPs to compete with multinational corporations head-on.

So why the new venture?

SF: We had taken people on [to cover me] at my practice in Nottingham while I had been at the BMA and I couldn't just return and say 'I'm back!'.

JC: Few people on the GP negotiating team have gone back to full-time general practice.

SF: I still do two days a week in Nottingham but general practice can get quite lonely. This is an opportunity to get my teeth into something else. There's something very exciting about planning and building a new business.

JC: I wanted to use the experience, skills and knowledge I had acquired. I also wanted to work with Simon.

Why south London? Neither of you has practised there.

SF: We both live in opposite ends of Southwark, plus Southwark PCT is very dynamic and this was a unique advert. It helps to do locuming ­ I've done two days there.

How will these practices differ from traditional general practice?

JC: There are ways we can work jointly between the practices, and we want to develop nursing roles and introduce more health care assistants.

SF: I hope 70 per cent of consultations can be led by somebody other than a doctor.

Don't you risk undermining

continuity of care?

SF: I really don't think a doctor needs to see every sore throat. Health care assistants are taking on a large part of chronic disease management and nurses are moving into roles that were traditionally medically-led.

I take issue with colleagues who say people won't like it.

How will staff roles change?

SF: We want to see them develop their own autonomy, acquiring prescribing rights, with doctors becoming consultants in their own organisations. I also see receptionists doing QOF searches, taking bloods, doing BPs, ECGs and new patient checks.

JC: We always said new GMS gave opportunities for the skills of other health professionals.

Any other innovations?

SF: Each practice will open at 7am one day a week and close at 8pm one day a week and open Saturday mornings. Patients can go to either practice as our computer system will be linked.

I see practice management as a role broken up into smaller entities and we are looking at centralising the back office.

SF: Space is tight and we are going to have to look at hot-

desking, but we can use

mobile trolleys so you don't go through a drawer looking for things.

When did you get the idea?

SF: We've been working on the idea for 18 months. We were thinking about what deregulation could mean.

JC: It was well after we had left the negotiating team.

How do you see the company


SF: We want to build a brand but we are a London organisation and we won't be chasing around the country.

We want to grow organically and intend to take on patients ­ word of mouth is very important but we also have two young people in marketing.

We are here for the long-term. I'm 56 and John is 55 so there's at least another nine years in it for us.

Do you expect to become wealthy?

SF: You can either see change as a challenge or an opportunity. At the moment it's making

me very poor and I will be out of my home if we don't make a profit, but profitable businesses are those which deliver the right product to the right


Do partnerships have a future?

JC: We are going to see increasing diversity. Partnerships have a great future for a great many practices. Equally there are a number of partnerships which are set up as companies. Partnerships are not the only way.

Can GPs really compete with big multi-national companies?

SF: There's no doubt it's got more competitive. We asked ourselves whether competition really has to mean big multi-

national independent companies. We are taking them on head-on and I'd like more colleagues to have a go.

We might have more experience but we are ordinary GPs.

But 'ordinary' GPs lost out to

UnitedHealth in Derbyshire

SF: You have to take it on the chin and accept that others may put a better deal together.

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