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As a super-practice we’re damned if we do, damned if we don’t

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One of the questions reverberating around Birmingham, where I am a GP, and perhaps wider afield, is, ‘Why a super-practice?’ rapidly followed by, ‘Why now?’ The answers to those questions, and the many more that some may have, will no doubt become clearer in the coming months. But I can’t help feeling that as an emerging super-practice we are damned if we do and damned if we don’t, in more ways than one.

As I have articulated before it seems that there is political pressure on practices to work together in larger groups, in the form of advice from the King’s Fund and also ‘information’ from the Department of Health about a potential ’alternative contract’. Only by working together could the Government’s aim of seven-day working (the so-called New Deal that has all but been forgotten with the furore about consultant and junior doctor contracts) be achieved whilst maintaining sanity and work-life balance. For many practices, working together offers the potential of savings on shared functions to help offset the stagnation or downturn of income.

So in forming a super-partnership we are damned if we do and damned if we don’t. If we form we are pandering to the desires of the Department of Health to make possible the ongoing promotion of consumerist health. If we decided against it or call it quits then we face all the issues of not being able to bid for integrated health services contracts in the future.

If we are successful as a super-partnership, both financially and conceptually, we’ll be damned by those that rightly value and guard their autonomy, for we could be held up as a model of how to successfully bind practices and deliver what patients would consider ongoing local general practice. If we became the pin-ups of the Government we’d be hated by everyone else for showing that there is another way of doing things.

If we fail as a super-partnership we will lose face, money and the possibilities in the future of having any say about the direction of general practice. We’ll be the laughing stock of general practice and many will think, write and say, ‘I told you so.’ We’ll be damned if we succeed, we’ll be damned if we don’t.

The decision to go ahead with a super-partnership is a philosophical one of choosing whether to be damned for doing, or for not, to be damned for succeeding or failing. When it comes to philosophy, quotes work better:

‘If you have tried to do something and failed, you are vastly better off than if you had tried to do nothing and succeeded. You must never regret what might have been. The past that did not happen is as hidden from us as the future we cannot see’ - Richard Martin Stern.

Dr Samir Dawlatly is a GP in Birmingham

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Readers' comments (14)

  • Vinci Ho

    As I said before , it is all about surviving.
    Fully respect your honesty and code of honour.
    Life is so often about making big decisions and about the choice between two evils rather than good against evil as George Orwell once said.
    On another tone, please tell us about super-practices not involving in GP training?

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  • Call me old fashioned, I prefer the past model of autonomous independent GP practices looking after a few thousand patients. Super practices I feel are just pandering to the government who have no idea what GP actually entails. Once super practices are the norm all contracts will go them and it will be the end of old fashioned general practice. Once the government starts to squeeze costs again GPs will reminisce about the good old days. The answer is not to agree with the worst case scenario but to fight tooth and nail to keep GP independent. Too late for that now!

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  • What autonomy? With NICE, CQC and every other body with an opinion dictating what you do, I wonder what autonomy is left that you feel needs to be protected. It seems to me that the only people exercising their clinical autonomy tend to be dodgy doctors who do not want to practice evidence based medicine. Or by autonomy do you mean the opportunity to risk your career and financial security in a cash strapped, litigious NHS?
    When will my fellow GP’s accept that the independent contractor status is a soul-destroying millstone. Federations, super-practices etc are simply desperate attempts to flog this dead and rotten horse leaving GPs with all the responsibility for a very sick NHS. Why not just be employed? No financial risk, no worrying about workforce, pointless care plans for which you may or may not be paid to create, CQRS returns…the list goes on. Just go to work and do what you are trained to do. Is that really such a terrifying prospect?

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  • Mark Essop | Sessional/Locum GP04 Nov 2015 11:32am

    How naive. Do you think being completely salaried comes with no strings, no regulation, no denigration, no micromanagement?
    Apart from the fact that salaried employees will be paid far less than what our professional qualification and training should enable us to earn, do you think NHSE, CQC, GMC, MDOs, NICE, managers, will all go away? The old ways might not be perfect, and I happen to support resignation from the NHS anyways, but being salaried is not going to be a bed of roses

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  • Perhaps part of the problem is the ambiguity inherent in using the term "super". Why not just call yourself a "very big" practice rather than risk being thought to be claiming superiority?

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  • Mark Essop | Sessional/Locum GP04 Nov 2015 11:32am

    do you really think that if GPs switch to a salaried service that care plans, DES' and LES' will simply disappear? no they will just be written in to the salaried contract. Do you honestly think Gov and DOH will not just keep piling on the work and force through the change in contract to state you must do all this crap or have no job? (they will simply change the model GMS contract)Do you really think they will protect pay and not just keep cutting it?

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  • Shame that GPs are always quick to criticise those trying something new and hark back to the halcyon days when all was "wonderful". The NHS (and country/government) are in a financial mess so I cannot see the billions of pounds we need coming our way any time soon. I remember doing a 1:1 on call when I was single handed, rushing out to deliver babies during a surgery, having no easy checking system for drug interactions, having to pull down the Oxford textbook of medicine to work out a diagnosis etc etc. Time moves on and so should we.

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  • I think it depends on the motivation. Are practices being driven to do this for whatever non-medical/non patient-based/political reason or is it a completely independent idea of the way general practice should be run? If the former, I think we are right to have reservations; they are not necessarily criticisms.

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  • SUPERPRACTICES!!!!!!!

    There is nothing SUPER about the way british GP's are treated or the way primary care is running nowadays.

    Keep deluding yourselves

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  • To the anonymous GP (it's ok you don't need to hide as we still live an democracy apparently. I am hardly naive but I should have been clearer. I am not saying you need to be permanently salaried. Sessional (especially locum) is preferable. Do it on your terms. Care plans and all these other ill thought out ideas may not disappear but as a sessional doctor you should be able to determine what activities you are prepared to engage in. And if you choose to participate in this additional work, at least you do it at the expense of the practice rather than your own, followed by waiting months to see if NHSE has decided whether they want to pay you or find an excuse not to.
    There is a shortage of GPs which means GPs should be determining what they will and will not do and not jumping every time they are told to. Currently GPs seem to take whatever is thrown their way regardless of their ability to deliver or the bottom line. There is a lack of dignity and self respect amongst GPs who seem to think that being a martyr is the same as being conscientious. The Government benefits from incredibly good value from GPs compared to the rest of healthcare – in fact so good that it is exploitative. Why else would they maintain the independent contractor model? These megalomaniacs would love to ditch this “independent” model but they cannot afford to financially. So instead they maintain the model but erode the autonomous element of it so that they have control but without the responsibility or risk which rests on the shoulders of GP partners. Just look at the rising cost of indemnity if you want a simple living example of this.

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