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At the heart of general practice since 1960

Good things come in small packages

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The GP news is full of the joys and opportunities of merging, creating bigger, more streamlined and efficient practices. We see the visions of centralising the boring clerical hoop-jumping tasks, utilising nursing and AHP skills to provide a full range of wholistic care facilities and deal with minor ailments so we don’t have to, freeing-up valuable GP time to concentrate on clinical complexities. What a wonderful utopian ideal with access to mental health support, physical and other therapies, community supports; and happy, enthused, relaxed GPs empowered to spend time with their patients, to do what drew them to medicine in the first place. Professional bliss…?

Argh, I feel dizzy, these rose-tinted glasses are giving me a headache…

I didn’t become a GP to be another worker on a conveyor belt, to see one patient after another, to be constrained as one of the cogs in a bureaucratic behemoth. I want to help people, help families, help communities. And for me that means using my knowledge and skills to influence, adapt and create the services that my patients need. OK, there may be advantages to quick access to physiotherapy and mental health counselling for depressingly bad back pain, but how could a large organisation deal with such a broad range of demographics seen in any urban sprawl, from affluent Acacia Avenue through to the boarded up terraces of Inequality Street? And don’t even get me started on how on earth you can provide quality, effective primary care services to remote or rural populations at scale when even now some patients have to travel up to 20 miles to see any GP, let alone the same GP.  

Large organisations are breeding grounds for the very silos and tribes we see bickering throughout the NHS. The bigger they get, the more bureaucratic they have to be to get things done, creating managers and sub managers, each with their own sticks and carrots to dangle over or whip the next tier down the command-and-control hierarchy. They stifle diversity, leadership and creativity. They are slower to respond to concerns and change; more steps, more decision-makers, more managers to pass-the-buck. Mergers and scale working are recurring themes in business, many for positive reasons, many to just save money on staff and property costs. All very well in a private manufacturing industry, but we are dealing with people, individuals, lives and livelihoods. 

Small practices are flexible, reactive to the needs of their communities, easily accessed and cost-effective when you look beneath the immediate top layer of outgoings. The problem is not the small-business organisational model, but the chronic, short-sighted, boa-like strangulation of resources by increasing demand, failure to invest and dwindling GP numbers.

Well, maybe mega-practices could work in Metropolis, who knows. But good things come in small packages.

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Readers' comments (2)

  • Couldn't agree more. I used to work in rural Canada many years ago. I only had around 600 patients (this is a difficult thing to assess as patients do not register with a practice) I only did one surgery / office session a day, but the practice had four GPs. We all used our previous hospital experience to run the local hospital including A&E, surgery, acute medical admissions, obstetrics... So we ran primary and secondary care in one. I'm not sure if that still goes on now because of the issues around accreditation, regarding the numbers of procedures that one needs to do on a yearly basis. However I loved the work and our patients adored the service. Sadly I think it is unlikely that still goes on now. It was the most enjoyable medicine that I have ever done.

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  • Hi Tony, thanks for your reply. Arran has a pop. Of about 5000. We run 3 FT and 2 branch surgeries, cover lol the OOH and give 24/7 cover for our 16-bedded hospital including A&E and HDU facilities ( for when the weather isolates us). This kind of medicine is alive ang kicking to serve many remote and rural communities in Scotland and other areas of UK.
    But the small-business nature is not a luxury for remote and rural communities,it is an essential. Could a mega-practice provide the flexibility of services and approaches to cope with acute, chronic, trauma, sepsis, 5000 islanders and up to 20,000 visitors at a time in Summer? I doubt it.
    Cathy

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