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At the heart of general practice since 1960

Urban practice: Erdington Medical Centre

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

If a packed waiting room is the sign of a busy practice, then the Erdington Medical Centre in Birmingham is a very busy practice indeed. As Pulse arrives, the waiting room is heaving with patients, some of whom are having to stand as they wait for their appointment. Dr Robert Morley, senior GP partner at the practice, says that although some of this is down to demand for seasonal and swine flu vaccinations, it is also indicative of the demands of the practice's 8,000-strong list.

‘It is very much patients with heavy needs and multiple problems, resulting in higher workload,' he says.

Erdington is not inner city per se as it is on Birmingham's outskirts, but it is a highly deprived urban area, and has not only inner-city problems, but also some particular to the locality. The practice is next to a former psychiatric hospital, whose patients were moved into accommodation close by, meaning there is a high prevalence of patients with mental health problems.

As Dr Morley explains, the practice also caters for homes for the mentally ill, nursing and care homes, and patients with learning disabilities. ‘We have a huge workload of mentally ill people, a lot of them with very significant illness,' he says. ‘We also see lots of very severely disabled epileptic patients with multiple pathology.'

The practice provides a range of tailored services for its local community, including a local substance abuse service. It also has a high number of immigrant patients on its list, with high rates of some chronic illness.

‘In lots of areas, such as hypertension, CHD and diabetes, our prevalence is way above average. To get our QOF points we have a very heavy workload,' says Dr Morley.

The surgery has a fairly high proportion of same-day compared with advance appointments, with 29% pre-booked, reflecting the demands of the patient list for quick access ahead of advance planning.

The surrounding area is rife with crime, which also has an impact on the practice. It was recently forced to install shutters and CCTV after suffering a series of break-ins.

Lots of the practice's patients are unemployed, which makes extended hours less of a necessity, although the practice has offered it since April this year, when it reorganised the way it runs the business.

In April, the practice merged with two neighbours, which have formed a larger hub with five other practices. In total, the new three-practice partnership now has 26 GPs serving 46,000 patients across two PCTs. All staff are employed by one partnership, and are still locally based. However, the practice hopes to develop flexible ways of working to enable staff to work across sites.

As the waiting room melee finally subsides, Dr Morley explains the reasons for the change – namely, to better cater for the demanding population, by allowing the practice to offer a greater range of services and share staff, skills and expertise more widely. It has also placed the business on a sounder footing as it competes with larger corporate providers and Darzi centres.

‘We have a very difficult patient base and workload, and we felt threatened by the commercialisation of primary care on our doorstep,' he explains. ‘We saw the way things were going and tried to look for a way to combine traditional general practice with a business model that allowed us to compete against large private providers.'

The merger may suggest a monolithic beast of a practice, but Erdington has tried hard to retain the characteristics of a family doctor's surgery. On current evidence, it appears to be succeeding.

Erdington Medical Centre

List size: 8,000 at surgery, 25,000 across practice, 46,000 across hub
Funding per patient: £68.50
Patient demographic: Highly deprived, broad spread of young and old
Location: Erdington, north-east Birmingham
Staff breakdown: Five GP principals (one part-time), two nurses (although currently recruiting to replace both of these), one healthcare assistant

Dr Robert Morley Dr Robert Morley

We felt threatened by the commercialisation of primary care in our area

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