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Independents' Day

There’s a reason small practices are so popular


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I still haven’t downloaded Mapp Hancock’s Matt Appcock app, so I don’t know what he’s had to say about the resignation of, ahem, ‘top GP’ Arvind Madan. I’m hoping he’s realised it’s time to begin a proper debate about the value of small practices, but I suspect he’ll actually say ‘hey, small practices are great, because the smallest of all is the one you can fit in the palm of your hand’.

But that’s not the sort of debate we need. Instead, we should probably start by confessing that we have all, by default or design, become complicit with the ‘bigger is better’ mantra. So loudly and persistently has this been chanted by the movers and shakers – some in suits but some with stethoscopes – that we have all been deluded, in a form of collective Madaness, into believing it.

Call them federations, networks or super-practices, the message is the same, usually couched in vacuous catchphrases: going forward, it’ll be survival of the fittest requiring strength in numbers to provide a general practice for the future, etc. And, by and large, we’ve chewed some grass, baa’ed and flocked in that general direction.

Yet I’ve always struggled with both the logic and the motive. The well-aired arguments about making us efficient and powerful rather than vulnerable and downtrodden are flimsy in theory and even flimsier in practice. As for political motives, you can take your paranoid pick from reducing costs, increasing control, nudging us towards a salaried service and so on.

What was once primary care will become the perfect place to dump all the work hospitals can no longer cope with

To a confused, knackered worker at the coalface, like me, the obvious rationale is that the Government wants to turn primary care into something that – with large organisations providing multiple services to huge populations – looks suspiciously like secondary care. Because that, in turn, makes what was once primary care the perfect place to dump all the work hospitals can no longer cope with but which creates politically embarrassing headlines every winter and beyond.

There’s one teensy problem, though: who’ll do all the general practice when GPs default to community care consultants? Yes, of course, nurse practitioners, pharmacists and other noctors, working in and around the megapractices. Which is where politicians show how wilfully clueless they are, and where the small practice argument really kicks in. There’s a reason small practices are so popular and, when allowed to, provide high-quality care: they’re run by people who know what they’re doing (GPs) offering, among myriad other worthwhile services, the most valuable commodity of all to patients who need good care the most (continuity).

Sacrifice that at your peril. The last time ministers tried to hive off a major chunk of GP work – out of hours – it didn’t go too well. This next step is, in effect, to deconstruct the day job. This brings me out in waves of nausea. The strongest arguments against it are staring the Government in the face, yet it refuses to see them. Most likely because ministers are looking in the wrong direction.

Dr Tony Copperfield is a GP in Essex


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Readers' comments (7)

  • National Hopeless Service

    Even Modality realises its got it very very wrong;

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  • Hairdressing salons across the country are closing down. The Hairdressers are being forced out of business by a new technology combined with a bigger is best mantra.

    Economies of scale mean that in a large chain of hairdressers only one administrator can track all the qualifications of the stylists, book all the appointments and make tea and sweep up in all the salons across the whole country.

    At the same time Hairdresser at hand and Barberon are competing to develop a new paradigm in coiffure. The online barbarism apps allow the young, fit, and hirsute to have their own selection of cranial topiary, martini style.

    Traditional barbers and stylists in quaint back street chop shops are being outpaced by this disruptive technology. Ed the scissors said " young people will miss us when we're gone the knowledge we have of which way their parting goes is indispensable."

    Spokesperson for Barberon states that 85% of hair dos can be done online. He seriously intends to sell his stake in the business for several million. He has advised his investors in a clear regulatory statement that 'there is absolutely no way you will make any money from this in your lifetime. Look we can only pay the day to day bills by stealing the cash from the cafe next door, and trading barber poles on the second hand market.'

    Hairdressing regulators and trades descriptions officers have been accused of taking bribes. They have repeatedly stated that online haircutting is a matter for the clients and that if the national hairdressing budget is all syphoned off to panama it will not have been their fault.

    Wicileeks was unable to cover the story due to current legal difficulties. Private eye did a 16 page spread, attracting the disbelief of hundreds of political watchers, but who forgot about it after their next editorial meeting.

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  • By the time they realize what they have done we will all be gone,this will be happening within the next 5 years.Total system collapse as more and more get caught in the workload/tax/pension/regulation/administration etc etc etc poison septic tank and decide to jump ship.?Can they run a system on locums alone mmmm.

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  • Maybe, just maybe, they are trying to improve it using ..... Homeopathy?
    Dilute it repeatedly with something inoffensive and then bang it repeatedly on the table.
    Hey Presto
    (coming to a practice near you soon - genius)

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  • Well said Copperfield. Thanks for taking a pick axe to the mega practice movement. why can no one see that 70 years of natural evolution produced no mega practices but lots of medium sized ones? The doctors and the patients organised themselves into the most efficient and happy work places and general practice used to be the jewel in the NHS crown. We lose it at our peril.

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  • Hear hear
    It’s time hardworking doctors in small practices were heard
    However the genie is out of the bottle and most GPs are realising that need a healthy work life balance and are not able to have what the government have previously call “work intensification” ( aka “worked to death”) forced on them and like the OOH changes the profession will now want a healthy lifestyle for themselves as well as for patients
    Hence early retirement, locum work etc is flourishing

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  • Just been to denmark and worked in v high quality practice which is big by their standards. 4 partners and 6000 patients. They can’t understand how megapractices can keep continuity or be more efficient

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